Percutaneous Thrombectomy of Clot in Transit Lodged in the Patent Foramen Ovale Using the FlowTriever Device: Case Report

A clot in transit is a venous thrombus lodged in the right heart en route to the pulmonary arteries. When a clot in transit lodges in a patent foramen ovale, it becomes an impending paradoxical embolism (IPDE), a rare, life-threatening condition with a 30-day mortality of 18.4%. Management options-surgical extraction, anticoagulation, or thrombolysis-lack consensus. We present the case of a 53-year-old man with a saddle pulmonary embolism, in whom postthrombectomy transthoracic echocardiogram revealed an IPDE. This case illustrates aspiration thrombectomy of the IPDE with the FlowTriever device (Inari Medical) with cerebral protection (SENTINEL, Boston Scientific), offering an alternative to thrombolysis and surgery.