ONE-PASS RESCUE IN A CAROTID OCCLUSION INVOLVING P-COM & AChA
NeVa™ 5.5 x 37 mm
Dr. med. Christian Commodaro
Medico Capoclinica, INR Unit, Lugano, Switzerland
Clinical Case Report
Presentation
A 55-year-old male patient with a mechanical heart valve presented with a fluctuating NIHSS ranging from 3 to 11.
Dr. med. Christian Commodaro
Medico Capoclinica, INR Unit
Lugano, Switzerland
Imaging Revealed:
1. Occlusion of the right internal carotid artery (R-ICA intracranial segment) involving P-Com & AChA.
2. Occlusion of the right P-Com in the context of a fetal type PCA.
3. A patent apex of the right carotid artery with normal intracranial circulation elsewhere.
CT Perfusion maps (T-MAX) showing hypo-perfused posterior cerebral artery and AChA territories on the right side.
Angiographic AP and LL views showing blood flow arrest in the R-ICA after the bulb (“stump flow”) due to the occlusion of the intracranial segment of the ICA
AP and LL images from the roadmap during the navigation across the occluded segment.
Selective injection into the right M1 segment to confirm the correct distal position of the microcatheter.
Treatment & Outcome
1st Pass:
Direct aspiration with a .071″ aspiration catheter
2nd Pass:
A different stent retriever (5 x 37 mm) associated with distal aspiration with the .071″ aspiration catheter (SAVE technique)
3rd and final pass: with NeVa 5.5 x 37mm associated with distal aspiration with the .071″ aspiration catheter (SAVE technique):
- NeVa was deployed between M1 (completely clot-free) and the ICA (occluded site)
- The degree of resistance during the procedure was comparable to that of a generic stent retriever
Two unsuccessful thrombectomy attempts were made prior to NeVa use. The NeVa pass achieved complete recanalization with no distal thromboembolism (TICI 3):
1st pass success:
TICI 3 in a single pass with NeVa 5.5 x 37mm
24-hr CT showed a small lesion in the anterior portion of the right thalamus and a marginal lesion in the adjacent right internal capsule
