Istanbul #1 | Vesalio

WAKE UP STROKE

Left M1 Occlusion 1st Pass Success
with NeVa™ M1 (4.0 x 30 mm)
Clinical Case Report
Presentation
61 year old male patient presented with
NIHSS of 10. The patient was last seen well 10.5 hours ago.
Imaging confirmed Left MCA occlusion
RAPID evaluation confirmed preserved
cerebral blood flow & volume with a mismatch score of 7.4.
Professor Dr. Serdar Geyik
Istanbul Istinye University
Medical Park Hospital
Istanbul, Turkey
Pre-op DWI
Pre-op Flair reveals hyper-intense vessels, slow flow and blooming artefact of the thrombus.
Pre op perfusion imaging with iSchemaView RAPID shows high DWI/PWI mismatch and preserved cerebral blood volume in the affected part of brain.
Ischemic Core 13ml
Mismatch Ratio > 1,3
  • Tmax>12.0s volume: 8 ml

  • Tmax>10.0s volume: 15 ml

  • Tmax>8.0s volume: 44 ml

  • Tmax>6.0s volume: 96 ml

  • Tmax>4.0 volume: 202 ml

  • Hypoperfusion Index (Tmax>10s/Tmax>6s): 0.2

The Procedure
No IV-tPA was given to this patient since it was a wake up stroke.
Professor Geyik and the Medical Park team decided to treat the patient with thrombectomy using a NeVa M1 (4 mm x 30 mm) under distal aspiration. Full recanalization was possible in a single pass.
Femoral route failure
Extreme vessel tortuosity necessitated radial access
Access was gained via Radial route with 80 cm sheath + 5 F DAC
Angio showing Left MCA (M1) Occlusion
First Pass Success with NeVa M1 (4mm x 30mm)
Thrombectomy was done under distal aspiration with NeVa M1 (4mm x 30mm) using captive technique (partial retrieval of NeVa into the DAC tip).

Full recanalization (TICI 3) was possible with a single pass and significant thrombus was observed within the device.
POST THROMBECTOMY TICI 3
Several minutes after recanalization, progressive narrowing of the MCA was observed, which was eventually treated with PTA and stenting.
PTA and stenting performed with Neuroform Atlas
POST STENTING
Procedural Statistics
Clinical Success
24 hour NIHSS of the patient was 2.
Patient evaluation at 1 month showed excellent recovery with an NIHSS score of 0 and mRS score of 0.
 
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 Istanbul!
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