Maintained patency and symptom resolution after treatment of recurrent in-stent thrombosis with novel RevCore thrombectomy system: A case report

Abstract

In-stent thrombosis (IST) is a frequent complication following intervention to remove thrombus and treat residual venous outflow obstruction or stenosis. Treatment is often limited to venoplasty and stent relining, which only temporarily restores stent patency until rethrombosis inevitably occurs. As a result, disease management becomes a cycle of repeated recanalization procedures without long-term relief. This report highlights an early use case of a novel device capable of debulking material in the peripheral vasculature and restoring patency to occluded stents. A 60-year-old male with a 25-year history of recurrent venous thromboembolism that included a 9-year history of recurrent IST had chronically occluded, overlapping, left-sided inferior vena cava to common femoral vein stents. He presented with worsening lower extremity (LE) swelling and bilateral non-healing ulcers, and diagnostic imaging revealed occlusive and nonocclusive material throughout both LEs with increasing thrombus burden compared to a few months prior. Stent recanalization and thrombectomy were performed successfully with the RevCore Thrombectomy System, an over-the-wire catheter with an expandable coring element designed for use in venous stents ranging from 10 mm to 20 mm in diameter. Following many years of rethrombosis and reocclusion after stenting, the patient’s postprocedural clinical status was significantly improved with patency and symptom resolution maintained at 8 weeks. Further evaluation is warranted to determine the effectiveness of these procedures; however, the case reported herein is an encouraging signal for a viable treatment option for IST beyond the temporary restoration of patency provided by conservative medical therapy, venoplasty, and stent relining.