For years, if you came into the emergency room with a pulmonary embolism or deep vein thrombosis (blood clots in the lungs or a vein, typically in the leg), doctors would put you on a medication to try to break up the clot as well as to thin the blood.
Those medications, though, come with side effects that include bleeding in the brain or having part of the clot break off and travel somewhere you don’t want them, like the heart.
Patients with the most serious cases, at immediate risk of death, would go immediately into surgery, says Dr. Peter Monteleone, interventional cardiologist at Seton Heart Institute.
This year, though, he’s been using a technique to get rid of blood clots that are serious but not the most critical or the most benign.
“It’s the whole group in the middle,” he says.
Monteleone is using the Inari FlowTriever for pulmonary embolisms. Using ultrasound to guide him, he inserts a guide wire through a vein to go through the clot in the lung. Then he inserts the FlowTriever catheter into the vein to reach the clot.
He deploys the FlowTriever’s three self-expanding nitinol (metal alloy) mesh disks. The disks attach to the clot and dislodge it. He then drags the clot back through the catheter to a syringe that is attached to the catheter outside the body.
It’s a bit like a plumber’s snake inside the body, gripping the clog and bringing it back through the pipe to the surface.
If the patient has a deep vein thrombosis, he uses the Inari ClotTriever, which acts similarly. A guide wire is inserted through a vein through the clot. The catheter with the ClotTriever is inserted through the clot. Then he deploys the nitinol ClotTriever, which looks like a cylindrical net, and grabs the clot. He can then drag it back through the catheter and into a collection bag outside the body. The ClotTriever also has a nitinol funnel by the catheter that keeps the clot from escaping as it’s being sucked into the catheter.
Both procedures can be done in about half an hour with the patient under light sedation, which means they are awake but not in pain.
“It’s not a big surgery,” Monteleone says.
Patients are put on blood thinners to prevent new clots from forming, but they don’t have to worry about the clot that was just removed migrating somewhere dangerous like the heart.
Signs of a pulmonary embolism include shortness of breath and pressure in the chest, dizziness or lightheadedness, a cough or coughing up blood. Deep vein thrombosis comes with swelling or pain in the leg, a feeling of warmth in the leg and redness in the leg.
Monteleone and his colleagues have been seeing fewer people coming into the emergency room for care like heart attacks, strokes and other serious problems like embolisms because of concerns about COVID-19.
“There are processes in place to keep them safe,” he says. “It is heartbreaking to know there are these therapies for patients that are treatments, and we’re not seeing them because they are scared.”