Percutaneous Mechanical Thrombectomy With The Clottriever Device For The Treatment Of Ilio-femoral Deep Vein Thrombosis: Initial Experience And Short Term Outcomes
Limael E. Rodriguez, MD, Andrew F. McChesney, MD, Huiting Chen, MD, Animesh Rathore, MD, Jean M. Panneton, MD, David J. Dexter, MD.
Eastern Virginia Medical School, NORFOLK, VA, USA.
OBJECTIVES: We aim to describe our initial experience with the ClotTriever system (Inari, Irvine, CA), a novel percutaneous device for the treatment of ilio-femoral deep vein thrombosis. It utilizes a nitinol mesh cage which is deployed and retrieved via a dedicated percutaneous sheath (13F).
METHODS: A retrospective review was performed of our initial experience utilizing the ClotTriever Device. We identified all ClotTriever devices used from January 2019 through August 2019. All patients treated were included. Primary end points were technical success of the thrombectomy, procedural success, and symptom improvement at short term follow up.
RESULTS: We identified 10 patients where ClotTriever was used as frontline or secondary thrombectomy. The mean age was 56 years (range: 35-83), and men were the most common sex in 7/10. Thrombus was located at the left limb in 6/10, right limb in 4/10 patients, and IVC extension in 2 patients. Iliac thrombus was present in 9/10 patients, Femoral and Popliteal thrombus was present in 8/10 patients. One patient had isolated femoral-popliteal DVT. The mean time from symptom onset to ClotTriever thrombectomy was 12 days (range: 2-22). Five patients were treated with ClotTriever as frontline therapy, and 5 patients were treated as secondary therapy after failure of pharmacologic or pharmaco-mechanical thrombectomy. Two patients were treated for iliac vein stent thrombosis. Mean operative time was 71 minutes (30-138 minutes). Extracted thrombus quality was acute in 2/10, acute-on-chronic in 5/10, and chronic in 3/10. Adjuvant maneuvers included balloon angioplasty in 6/10 and stenting in 1/10. Two ClotTriever procedures used TPA intraoperatively.Thrombus was successfully extracted in 10/10 patients. One patient required utilization of a secondary thrombectomy device for incomplete thrombectomy, the remainder were satisfactory. Inline flow was established in all patients. There were no access related complications. Mean procedure to discharge time was 2.7 days. At a mean follow-up time of 59 days (range, 29-132 days) there were no re-interventions. Edema was improved in 8/9 patients and pain was improved in 9/9 patients.
CONCLUSIONS: In our experience, the ClotTriever system is safe and effective for the treatment of acute and subacute DVT. We had a high technical and procedural success rate in frontline and secondary thrombectomy. Our early experience demonstrates a promising future for the ClotTriever as a percutaneous mechanical thrombectomy device.
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