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.