Case Study: Bilateral Pulmonary Thrombus Burden Rapidly Removed with Lightning Flash 3.0 While Minimizing Blood Loss

Dr. Adam Reichard, MD, a vascular surgeon at the TriHealth Heart and Vascular Institute in Cincinnati, shares a recent case in which he used Lightning Flash^® 3.0 to successfully remove thrombus from a patient with a saddle pulmonary embolism (PE). The upgraded Lightning Flash 3.0 system features enhancements designed to accelerate clot removal and increase fluid savings. In this case, the device enabled rapid, effective thrombus extraction while helping to minimize blood loss.

The following case study was originally published in Endovascular Today.

Patient Presentation

A man in his late 60s presented to the hospital with a 1-week history of persistent shortness of breath. On presentation, the patient was tachycardic with a normal blood pressure. Labs were significant for elevated troponin levels. CT demonstrated right heart strain, with a RV/LV ratio of 1.4. Additionally, bilateral pulmonary thrombus was identified, including a large saddle component. Transthoracic echocardiography confirmed RV strain.

Intervention

Initial access was obtained via the right common femoral vein using an 8-F sheath that was upsized to a 17-F Element™ sheath, and Lightning Flash 3.0 was advanced over a 0.035-inch wire into the right pulmonary artery (PA). With the Lightning Flash 3.0 aspiration catheter positioned, the 0.035-inch wire was removed and 10 mL of contrast was loaded into the catheter, followed by a 20-mL saline flush to deliver the contrast into the right PA vasculature. Angiography demonstrated an occlusion in the right upper lobar artery.

The aspiration catheter was then torqued and positioned proximal to the occlusion, at which point aspiration was initiated. The Lightning Flash console illuminated yellow, and the valve cadence increased, indicating catheter engagement with thrombus. The Lightning Flash 3.0 catheter was retracted toward the right main PA. Upon retraction, a large thrombus burden was seen being evacuated through the system. Subsequently, the Lightning Flash system transitioned to sampling mode, indicating the target segment had been cleared. Repeat contrast injection via the Lightning Flash catheter confirmed resolution of thrombus.
Attention was directed to the left main PA, which contained the majority of the thrombus burden. With the wire in place, the double-bend HTORQ tip configuration of the Lightning Flash 3.0 catheter facilitated seamless access into the left main PA for pre-thrombectomy imaging, revealing extensive thrombus. Aspiration was initiated, and the target thrombus was successfully removed in three passes.

Discussion

In total, cumulative aspiration time was 6 minutes, and the interval from initial imaging to device removal and access site closure was 25 minutes. Estimated blood loss for this bilateral PE intervention was 100 mL.

The enhanced aspiration power of Lightning Flash 3.0 was evident, as demonstrated by the rapid aspiration time and the successful removal of this large thrombus burden, allowing the patient to be taken off the table as soon as possible. The improved accuracy of the clot detection algorithm incorporated into the Lightning Flash 3.0 software was apparent and enabled minimization of blood loss.