case_images: PMC8298113_01
case_images: A large, saddle pulmonary embolism (arrows) shown in computed tomography
  angiogram of the chest, axial view.
case_images: mdcvj-17-02-e33-g1.jpg
case_images: PMC8298113_01_mdcvj-17-02-e33-g1.jpg
case_images: F1
case_images: Computed tomography angiogram of the chest revealed a large saddle embolism extending to the segmental branches, with right ventricular (RV) strain (Figure 1) as well as diffuse patchy ground-glass opacities consistent with COVID-19 pneumonia.
case_images: Fluoroscopic image of the SENTINEL cerebral embolic protection device (Boston
  Scientific) with proximal basket in the brachiocephalic trunk and distal
  basket in the proximal left carotid artery.
case_images: mdcvj-17-02-e33-g2.jpg
case_images: PMC8298113_01_mdcvj-17-02-e33-g2.jpg
case_images: F2
case_images: The SENTINEL cerebral protection system (SCPS, Boston Scientific) was deployed through a 6F sheath in the right radial artery (Figure 2), and the AngioVac system (Angiodynamics, Inc.) was deployed according to standard practice.
case_images: Transesophageal echocardiogram shows the AngioVac System cannula (arrow)
  retrieved back into the right atrium across the patent foramen ovale. The
  left atrial portion of the clot (X) is visualized, as is the right atrial
  portion of the clot (*).
case_images: mdcvj-17-02-e33-g3.jpg
case_images: PMC8298113_01_mdcvj-17-02-e33-g3.jpg
case_images: F3
case_images: Using the 25F sheath, we inserted an AngioVac curved cannula into the right atrium to apply extracorporeal retrograde flow up to 3 L/min (Figure 3).
case_images: Transesophageal echocardiogram and clinical specimen. (A) Negative flow
  applied using the AngioVac system's inflow aspirates the clots in a
  retrograde fashion into the right atrium across the patent foramen ovale.
  Microcavitation is seen on the right chamber and leftward interatrial
  septum. (B) Post clot extraction. (C) Extracted specimen.
case_images: mdcvj-17-02-e33-g4.jpg
case_images: PMC8298113_01_mdcvj-17-02-e33-g4.jpg
case_images: F4
case_images: On inspection, the clot was already organized (Figure 4), and it was retrieved through the patent foramen ovale (PFO) without any systemic embolization.