Clinical Case Report
Presentation
69 year old male patient presented with a NIHSS of 22, two and a half hours after symptom onset.
Imaging confirmed occlusion of distal left internal carotid artery (carotid-T occlusion).
Dr. Alejandro Tomasello
Vall d’Hebron Hospital
Barcelona/ SPAIN
Pre-op CT
The Procedure
Dr Tomasello and the Vall d’Hebron team decided to treat the patient by administering IVtPA (9 mg bolus and 81 mg) and endovascular thrombectomy. Femoral approach was used for access and the team decided to do co-aspiration (Solumbra) as a flow control strategy. CTA confirmed the occlusion of the terminal left ICA and ipsilateral A2 branches.
During the procedure, the first two passes in the ICA were done using 2 conventional stent retrievers with the “kissing technique”. When these passes did not give the desired result, a NeVa 6 x 44 mm was used to achieve full recanalization (TICI 3) in a single pass. A final pass was done to clear up the ipsilateral A2 occlusion.
Angio Showing the CAROTID T Occlusion
1st pass: “Kissing” or “Overlapping Stent” Technique Using 2 Stent Retrievers + Co-aspiration
Treatment in the ICA: First 2 passes using “kissing technique” with 2 conventional stent retrievers.
Due to the typical high clot burden expectation from a Carotid T occlusion, Dr Tomasello initially decided to use 2 conventional stent-retrievers (6 x 40 mm & 4.5 x 40 mm) and employed the “kissing technique”.
The size of the DAC used for co-aspiration during all three passes was: 0.071´´ x 132 cm.
Angio Showing Recanalization After The 1st Pass
3rd pass: NeVa 6 x 44 mm + Co-aspiration in Left MCA
Treatment in the ICA: 3rd pass using NeVa
Following the failure of the first two passes at achieving recanalization, Dr Tomasello decided to give the largest NeVa (6.0 x 44 mm) a try on its own.
Full recanalization (TICI 3) was possible with a single NeVa pass.
The size of the DAC used for co-aspiration during all three passes was: 0.071´´ x 132 cm.
Angio Showing Recanalization After the 3rd Pass with NeVa
ACA (A2) Pass: Smaller Stent-Retriever + Co-Aspiration
Treatment in the ICA:
A smaller stent-retriever was used in this more distal branch and full recanalization (TICI 3) was possible.
The size of the DAC used for co-aspiration was: 0.035´´ x 160 cm.
Angio Showing Recanalization of Left ACA
Post-Op CT
Procedural Statistics
Procedural Statistics
24 hour NIHSS of the patient was 21.
At VESALIO, we feel blessed to be part of the stroke field where together with these dedicated physicians, we can make an incredible impact on people’s lives.
Thank you Vall d’Hebron!
