Initial experience and early outcomes of treatment of complex deep vein thrombosis with flowtriever and clottriever mechanical thrombectomy systems in conjunction with protrieve sheath

Introduction

The study aims to establish that the ClotTriever and/or Flowtriever Systems, used in conjunction with the Protrieve sheath, can safely remove large thrombus burden associated with complex DVT while, in pertinent cases, also preserving the structural integrity of the IVC filter during catheter deployment, thus minimizing complications and reducing case complexity.

Methods

A retrospective review of all patients who underwent mechanical thrombectomy for complex DVT at New York Presbyterian-Brooklyn Methodist Hospital from February 2022 to August 2024 was conducted. Patient demographics as well as baseline characteristics including comorbidities, presenting symptoms, and initial imaging findings were collected. Intraoperative and postoperative outcomes were analyzed.

Results

The mean age was 76.5 years old, and 60 % were female. Of the anatomical location of thrombus, 60 % of thrombi extended into in the IVC. Concomitant subsegmental pulmonary embolism was found in 85 % (6/7) of these patients. Native vein thrombectomy was successfully achieved in all cases using a Triever catheter in 90 % (9/10) of cases and a ClotTriever device in 40 % (4/10) of cases. The Protrieve sheath was used to capture intraprocedural emboli in 90 % (9/10) of cases. Thrombectomy of an IVC filter was performed in 40 % (4/10) cases. Intraoperative patency improvement of treated vessels was confirmed via imaging in 100 % of cases. No serious adverse events occurred. 90 % of patients had complete resolution of edema and pain.

Conclusion

The initial single-center experience with the Protrieve sheath used in combination with the FlowTriever and/or ClotTriever mechanical thrombectomy devices for the treatment of proximal DVT that is bilateral, involves thrombosis of the IVC, and/or thrombosed IVC filters appears safe and effective with 100 % flow restoration, no serious adverse events including iaotrogenic PE, and no rethrombosis during the follow-up period.