32 - Single-Operator Observations Utilizing Intracardiac Echocardiography for Evaluation of Right Heart Embolic Debris

Mugtaba Swar-Eldahab, MS-III – Medical Student, Indiana University; Sabah Butty, MD – Interventional Radiologist, RADIOLOGY & IMAGING SCIENCES, Indiana University

Purpose: Clot in transit and intraprocedural embolic debris within the right heart in the setting of pulmonary embolism is associated with high morbidity and mortality. This single-arm retrospective analysis evaluates the utility of intracardiac echocardiography for identifying clot in transit and other embolic debris in cases of pulmonary artery thrombectomy.

Material and Methods: A local radiology informatics database was queried between August 2022 and August 2024 identifying patients who had undergone pulmonary artery thrombectomy with intracardiac echocardiography by a single operator. Intracardiac imaging was performed before and after thrombectomy, evaluating the right atrium, right ventricle, and right ventricular outflow tract. The primary outcomes of interest were the presence of clot in transit missed on preprocedural computed tomography and the incidence of “lollipopping” with inadvertent creation of right heart embolic debris. The secondary outcome of interest concerned technical success, defined as a high angiographic resolution of thrombus burden (>75%). Hemodynamics were also assessed.

Results: 128 consecutive patients who underwent mechanical thrombectomy with intracardiac echocardiography were identified. Average patient age was 60.4 years and 52% were male. Clot in transit was identified on preprocedural computed tomography in 1.6% of cases (n=2). Intracardiac echocardiography identified no additional cases of clot in transit before or after suction thrombectomy. There were no findings of new right heart embolic debris secondary to “lollipopping.” Target resolution of thrombus burden on post-thrombectomy angiography was met in 99.2% of cases (n=127), with technical failure in one case relating to chronic embolic debris not amenable to intervention. Mean pulmonary artery pressure prior to thrombectomy was 26.9±8.1 mmHg, improving to 21.4±7.5 mmHg following thrombectomy. No adverse events or procedural complications were reported.

Conclusions: There is limited utility for intracardiac echocardiography during pulmonary artery thrombectomy when evaluating for clot in transit and other embolic debris. Clot in transit is easily diagnosed on preprocedural computed tomography when present and embolic debris secondary to “lollipopping” occurs rarely and without clinical significance when identified.