Endovascular Extraction of an Aortic Arch Thrombus Using Dual Snares and Aspiration Thrombectomy.

BACKGROUND

Aortic mural thrombi are rare causes of embolic stroke and pose therapeutic challenges, particularly in critically ill patients.

CASE SUMMARY: A 47-year-old man presented with middle cerebral artery infarction. Imaging revealed a large, mobile mass in the aortic arch, suspected as the embolic source. Surgical removal was contraindicated owing to cerebral hemorrhage, and an endovascular approach was chosen. Using a cerebral protection device, dual snares, and a large-bore aspiration catheter, the thrombus was successfully removed without procedural complications. Histology confirmed an organized thrombus. Despite technical success, the patient died from complications of malignant stroke.

DISCUSSION: This case highlights a unique endovascular strategy for removing an intra-aortic structure. The combined use of aspiration and snaring devices enables safe extraction, with cerebral protection minimizing embolic risk. This approach may serve as a valuable alternative to surgery in selected high-risk patients.

TAKE-HOME MESSAGE: Minimally invasive removal of aortic thrombi is feasible and may reduce embolic risk in critically ill patients.