Endovascular Treatment of Pulmonary Embolism

[Dr. Thomas Tu]
The ideal placement of the Triever aspiration catheter is right at the proximal edge of the clot. I recommend that you start aspirating proximally first. That reduces the chance that you're going to push the clot further into the lungs and perhaps cause it to become occlusive and then, if you can aspirate right on the proximal edge, I think you'll have the best luck. If there's a long saddle, oftentimes because the saddle of the pulmonary arteries is quite a large structure and it might be hard to get close enough, that would be the one exception where I actually will try to pull the clot out from the distal end and pull it out backwards. And usually you can snare it around the area of the bifurcation of the truncus anterior and the intralobar artery on the right or around the intralobar artery basal trunk on the left. Those are common locations to grab the clot successfully.