Percutaneous Aspiration Thrombectomy for a Large Right Atrial Thrombus in a Critically Ill Patient

BACKGROUND: Right atrial (RA) thrombi are rare, potentially fatal, and lack standardized interventional treatment strategies. CASE SUMMARY: A 52-year-old dialysis-dependent woman with type 1 diabetes and prior pancreas and kidney transplantation presented with catheter-related sepsis. Transesophageal echocardiography and cardiac magnetic resonance imaging revealed a large RA thrombus (4 × 2 cm) in contact with the tricuspid valve. The infected dialysis catheter was removed. Given prohibitive surgical risk, percutaneous aspiration using the FlowTriever system was performed, resulting in near-complete thrombus removal. A small residual thrombus was managed with systemic anticoagulation. Follow-up imaging demonstrated complete thrombus resolution at 1 year. DISCUSSION: This case demonstrates the potential feasibility of large-bore aspiration thrombectomy for RA thrombi in high-risk patients and highlights the role of multimodality imaging in diagnosis and follow-up. TAKE-HOME MESSAGE: Percutaneous aspiration thrombectomy may offer a viable alternative to surgery for selected patients with large RA thrombi.