112 - Percutaneous Mechanical Thrombectomy with the Inari ClotTriever Device in a Pediatric Population
Kan Chen, MD – Resident Physician, Interventional Radiology, Northwell Health; Nicholas Voutsinas, MD – Attending Physician, Interventional Radiology, Vanderbilt University Medical Center; Amir Noor, MD – Attending Physician, Interventional Radiology, NYU Langone Health
Purpose: Pediatric deep venous thrombosis (DVT) is rare, resulting in significant morbidity due to post-thrombotic syndrome (PTS). Catheter directed therapy (CDT) and percutaneous mechanical thrombectomy (PMT) can decrease PTS severity in iliofemoral DVT and have been described in the pediatric population, usually reserved for limb-threatening cases. Inari ClotTriever (Inari Medical, Irvine, California) is a large-bore PMT device described for DVT removal in adults. We describe its use in a pediatric population.
Material and Methods: We reviewed three cases of patients who underwent ClotTriever PMT at our pediatric hospital in 2020-2021. Iliofemoral DVT was diagnosed using ultrasound and MRV or CTV, which showed no extrinsic compression.
Results: Case 1: 17-year-old on oral contraceptive pills (OCP) with left leg pain, found to have left iliofemoral DVT. Patient failed to improve after 5 days of systemic anticoagulation. After unsuccessful overnight CDT and rheolytic PMT, patient was treated with ClotTriever device and overnight CDT, with clot resolution on final venogram. No acute bleeding complications occurred. Patient was discharged on apixaban (Eliquis). On 3-month follow-up, patient had improved symptoms and imaging demonstrating patent left lower-extremity veins.
Case 2: 11-year-old on OCP with right leg pain, found to have right iliofemoral DVT. Patient failed to improve after 4 days of systemic anticoagulation and thrombolysis. After unsuccessful rheolytic PMT, patient was treated with ClotTriever device, with clot resolution on final venogram. No acute bleeding complications occurred. Patient was discharged on apixaban (Eliquis). Patient had symptom resolution on 6-month follow-up.
Case 3: 15-year-old with PCOS on OCP with right leg pain and dyspnea, found to have right iliofemoral DVT and segmental pulmonary embolism. Patient was started on systemic anticoagulation overnight and treated with single session ClotTriever PMT with an embolic protection device, with resolution of clot burden on final venogram. No acute bleeding complications occurred. Patient was discharged on subcutaneous enoxaparin (Lovenox) after improvement in symptoms, with plans for follow-up.
Conclusions: We describe the safety and feasibility for large-bore PMT with Inari ClotTriever in the pediatric population for acute iliofemoral DVT. Further investigation into its safety and efficacy should be explored in the pediatric population.