Single-Center Experience with Thrombolytic-Free ClotTriever Mechanical Thrombectomy for Deep Vein Thrombosis

Purpose: The clinical evidence guiding treatment of deep vein thrombosis (DVT) remains inconsistent. Catheter-directed thrombolysis, which has been shown to lessen the severity of postthrombotic syndrome compared with anticoagulation alone, comes with increased risks of major bleeding, including intracerebral hemorrhage. We describe our experience with rapid, single-session percutaneous mechanical thrombectomy of proximal DVT using the ClotTriever System, which avoids the need for thrombolytic drugs. In this case series, we aim to share our interventional decision making in different symptomatic DVT settings and assess the ClotTriever System’s ability to extract the thrombus burden safely and effectively.

Materials and Methods: We retrospectively analyzed the charts of the initial nine patients with DVT treated in our hospital with ClotTriever thrombectomy with a focus on procedural success (thrombus removal), safety, clinical success (acute symptom improvement), and length of hospital and intensive care unit (ICU) stays.

Results: Twenty-five patients presented with varying DVT presentations, including extensive occlusive DVT, phlegmasia, chronic thrombosis, and thrombolysis-resistant disease. All patients were treated in a single session, with two receiving combination therapy with the FlowTriever System to target inferior vena cava thrombosis. We successfully extracted thrombus in all cases (100% procedural success). All patients tolerated the procedure well, showed acute symptom improvement (100% clinical success), and were discharged the following day without ICU stay after thrombectomy.

Conclusions: ClotTriever mechanical thrombectomy for DVT appears safe and effective with all patients showing acute symptom improvement and none requiring ICU stays. Patients with a variety of DVT presentations were successfully treated without the bleeding risks associated with thrombolytic drugs.