A Novel Case of Cardiac Tamponade after Percutaneous Pulmonary Embolectomy Using the FlowTriever Retrieval/Aspiration System

INTRODUCTION: Percutaneous embolectomy using the percutaneous large-bore aspiration embolectomy FlowTriever system (INARI Medical, Irvine, CA, USA) is a promising method for reducing high clot burden in patients with intermediate- to high-risk pulmonary embolism (PE). CASE DESCRIPTION: A 45-year-old woman with intermediate- to high-risk PE underwent percutaneous intervention using the FlowTriever retrieval/aspiration system. After the procedure, she experienced several cardiac arrests from pericardial tamponade and required pericardiocentesis, leading to haemodynamic stabilization. DISCUSSION: To our knowledge, this is the first documented case of the use of the FlowTriever system causing micro-perforation of the right ventricle, resulting in tamponade and cardiac arrest. CONCLUSION: Percutaneous embolectomy has shown promise results in reducing clot burden and improving haemodynamic stability but has risks and limitations and requires specialized knowledge and training. In addition, more data are required from centres using the FlowTriever system to ensure adequate training and safety. LEARNING POINTS: Percutaneous mechanical thrombectomy using the FlowTriever or similar devices can be paramount in reducing morbidity and mortality from an intermediate- to high-risk pulmonary embolism given the immediate improvement in haemodynamics that cannot be achieved by anticoagulation alone. Cardiac micro-perforation is a potential complication of catheter-based embolectomy devices such as FlowTriever and should be suspected in the setting of pericardial effusion following the procedure.