Right Ventricular Perforation and Cardiac Tamponade Post-FlowTriever® System Treatment in High-Risk Pulmonary Embolism: A Rare Complication

Catheter-directed thrombectomy (CDT) using the FlowTriever® system offers promising results and could represent a paradigm shift in reducing morbidity and mortality of patients with intermediate-high and high-risk acute pulmonary embolism (PE). However, it is crucial to be aware of the risks and limitations associated with this technique. We present an extremely rare case of a 44-year-old male patient diagnosed with cerebral venous thrombosis of the transverse and sigmoid venous sinuses complicated by hemorrhagic lesions, who developed a high-risk PE within 24 hours of admission. Due to concomitant contraindications for anticoagulation in a patient with intracranial hemorrhage, the FlowTriever® system was chosen as the preferred intervention despite its associated risks. CDT was performed, provoking right ventricular perforation and cardiac tamponade immediately after the procedure. Only one previous case has been reported describing this extremely rare complication following FlowTriever® CDT. We reviewed the literature on indications, efficacy, and safety of this procedure, as well as our experience with this technique in patients with intermediate-high- and high-risk PE, clarifying whether prior reports included only FlowTriever® or other CDT devices. Additionally, we discuss the clinical implications of this case, highlighting the importance of careful patient selection when considering CDT in high-risk PE cases with contraindications for anticoagulation.