Neva saves the DAY AFTER A 5-PASS ORDEAL

NeVa™ 4.5 x 37 mm
Bucharest University Emergency Hospital Stroke Team

Clinical Case Report

Presentation

80 year old male patient presented with a NIHSS of 24, 4 hr 15 min after symptom onset.

The patient was transferred to the Bucharest University Emergency Hospital Stroke Unit after tPA administration in secondary center.

Imaging confirmed occlusion of the left M1 segment.

Dr. Bogdan DOROBĂȚ,

Dr. Adela DIMITRIADE, Dr. Alexandra CARP, Dr. Andrei SIMONOV, Dr. Mihai IONESCU

Bucharest University Emergency Hospital

Bucharest/Romania 

Pre-op Imaging

Pre-op CT confirmed acute ischemic stroke with some early ischemic changes in the deep left MCA territory. ASPECTS score of 7

CTA confirmed left MCA occlusion in the M1 segment. Poor collateral flow was noted.
Summary of the treatment

IV-tPA was administered at secondary center prior to the patient being transferred to the Bucharest University Emergency Hospital Stroke for mechanical thrombectomy.

Femoral approach was used for access and the team decided to use a 9-French balloon guide catheter (BGC) as a flow control strategy. Aspiration was done through the BGC during retrieval. A 0.027” microcatheter was used for device delivery.

5 thrombectomy passes were done with no improvement on the initial TICI-0 occlusion status:

  • The initial 3 passes with a 4.0 x 32 mm stent-retriever,
  • 2 additional passes with a 6.0 x 40 mm stent-retriever

For the 6th pass, a Neva 4.5 x 37 mm was used. Initially, NeVa was incorrectly positioned (too proximally – thrombus at level of distal basket). After correct positioning, complete recanalization (TICI 3) of the occlusion was achieved with a single pass.

5 PASSES PRIOR TO NEVA USE

9F Balloon Guide Catheter was placed in distal ICA. After 5 successive passes with two different stent-retrievers (4.0 x 32 mm and 6.0 x 40 mm) the initial left-M1 occlusion remained in place.

Initial angio showing the left-M1 occlusion

A pass with a 4.0 x 32 mm stent retriever positioned in the MCA

Angio after 5 passes with conventional stent retrievers, showing lack of recanalization (still TICI 0)
THE NEVA PASS
Complete recanalization of TICI 3 was possible with the the NeVa 4.5 x 37 mm pass

NeVa 4.5 x 37 mm positioned across the upper branch of the MCA

Angio showing TICI 3 complete reperfusion with slight, non-flow-limiting vasospasm of the upper MCA branch. The vasospasm resolved spontaneously without recourse to medication
“White” thrombus was observed partially inside Neva device
Position of “bifurcated” thrombus shown for reference
Post-Op CT

12-hour Post-op CT shows contrast staining of the lenticular nucleus

48-hour Post-op CT shows infarction of the deep territory – also partially visible on pre-Op CT, with a slight petechial hemorrhage. No other ischemic changes.
Procedural Statistics
Clinical outcome

24 hour NIHSS of the patient was 23, which later improved to 18.
The patient remained hospitalized with signs of aspiration pneumonia unrelated to the thrombectomy.

At VESALIO, we feel blessed to be part of the stroke field where together with these dedicated stroke teams, we can make an incredible impact on people’s lives.

Thank you Bucharest University Emergency Hospital stroke team: Dr. Bogdan DOROBĂȚ, Dr. Adela DIMITRIADE, Dr. Alexandra CARP, Dr. Andrei SIMONOV, and Dr. Mihai IONESCU.