From Escape to Extraction: Successful Endovascular Retrieval of an Embolized Watchman FLX Device Using the ONO Retrieval System

Document Type

Conference Proceeding

Publication Date

4-24-2026

Abstract

Introduction:
Device embolization is a rare but potentially catastrophic complication of left atrial appendage closure (LAAC), occurring in < 1% of cases. Most events occur early (< 24 hours) and frequently necessitate surgical retrieval. Advances in endovascular techniques now offer minimally invasive alternatives. We present a case of successful percutaneous retrieval of an embolized Watchman FLX device using the novel ONO Retrieval System in a high-surgical-risk patient.

Clinical Case:
A 78-year-old male with paroxysmal atrial fibrillation (CHA₂DS₂-VASc score of 4), prior CABG and TAVR, and recent gastrointestinal bleeding on oral anticoagulation underwent LAAC with a 35-mm Watchman FLX device. Initial intraprocedural imaging with intracardiac echocardiography (ICE) and fluoroscopy demonstrated appropriate positioning, adequate seal, and compression of 13–19% without peridevice leak.

Following device release, repeat imaging revealed positional shift with reduced compression (~8%), consistent with partial embolization into the left atrium. Under transesophageal echocardiographic guidance, repeat transseptal access was obtained using a 17F steerable sheath. A 26F Gore DrySeal sheath was advanced, and the ONO Retrieval System with a 2.4-mm forceps was deployed. The device was successfully grasped, recaptured, and extracted into the sheath without hemodynamic compromise, embolization to systemic circulation, or pericardial effusion.

The patient was extubated within 24 hours, remained hemodynamically stable, and was discharged on post-procedure day 3. Outpatient cardiac CT angiography and consideration for reattempted LAAC with an alternative device (e.g., Amulet) were planned.

Discussion:
This case highlights the evolving role of dedicated endovascular retrieval systems in the management of LAAC device embolization. Traditional approaches using snares or bioptomes may be limited by suboptimal control and alignment. The ONO Retrieval System enabled precise grasping, improved coaxial alignment, and controlled extraction, minimizing risk of vascular or intracardiac injury.

Emerging registry and bench data suggest that percutaneous retrieval is feasible in >75% of cases when embolization is recognized early and appropriate tools are utilized. In high-surgical-risk patients, this strategy may significantly reduce morbidity compared with open surgical retrieval.

Conclusion: Endovascular retrieval of embolized Watchman FLX devices using the ONO Retrieval System is feasible, safe, and effective in appropriately selected patients. Early recognition, multimodality imaging, and availability of advanced retrieval platforms are essential to optimize outcomes and avoid surgical intervention.

Comments

Society for Cardiovascular Angiography and Interventions SCAI 2026 Scientific Sessions & CAIC ACCI Summit, April 23-25, 2026, Montreal, Canada

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