NeVa™ 4.5 x 37 mm

Courtesy of,

Prof Geyik & Dr Bajrami

Aydin University Hospital Istanbul, Turkey

This case was transmitted live during the iCureStroke 2022 meeting.

Full of surprises, the case started out with the patient presenting with signs of hemianopsia and relevant PCA-territory DWI restriction, suggesting an acute occlusion of the PCA. Albeit initial presentation, diagnostic angiography revealed an ipsilateral blockage of the ICA, mimicking a chronic occlusion, with filling of the ipsilateral MCA from the opposite side. The biggest surprise was the discovery of the fetal-type-PCA anatomic variant and the occlusion of the PCA origin, explaining the initial presentation with PCA-stroke symptoms.

The technical challenge was removing the high clot burden from the ICA without jeopardising the downstream territories, which remained fully intact. Any fragment loss would have compromised the MCA territory, worsening the patient outcome.

Watch the case in real-time as Prof Serdar Geyik and his team forge ahead despite the challenges. Take in the comments and recommendations of the iCureStroke meeting faculty as they discuss relevant evidence and statistics at each step.

Play Video

00:00  Introduction

02:14  Groin puncture & discussion on the case presentation

04:28  A chronic ICA occlusion on top of a PCA occlusion?

11:56  Posterior Circulation Angio

14:52  Anterior Circulation Angio

18:30  Is this a pseudo-occlusion? Exploration of the lesion

23:58  A change in access strategy, discussion on the shape and size of the thrombus

26:47  Large clot burden expected: Discussion on the ideal technique and stent-retriever

32:30  Intracranial access and further discussion on treatment choices

35:00  Thrombectomy with NeVa 4.5 x 37 mm: navigation, deployment, retrieval

38:04  1st Pass TICI 3 recanalization & what is specific about NeVa

41:46  Thrombus inside NeVa

43:14  What I love the most about the case…

47:24  Revision of the material employed, further comments and closure

Vesalio would like to thank the iCureStroke meeting organization and faculty, Professor Serdar Geyik, Dr Arsida Bajrami, and the Aydin University Hospital Stroke staff, as well as Professor Raul Nogueira presenting the case, and the iCureStroke faculty members for this valuable learning experience.