NEVA IN AN I-TYPE ICA OCCLUSION WITH MANY SURPRISES:
LIVE CASE TRANSMISSION FROM iCureStroke 2022
NeVa™ 4.5 x 37 mm
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
Chapters
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.