Thrombectomy - When a small succeeds where a big cannot

Author: Bruyere Pierre-Julien

First thrombectomy (Solitaire™ X 4x40 mm) under aspiration with good results but persistent superior M2 occlusion. Thrombectomy under aspiration of the superior M2 branche with Solitaire™ X 4x40 mm unsuccessful then successful thrombectomy with Solitaire™ X 3x40 mm.

• Case presentation
  • Patient, 68-year-old, admitted 30 minutes after symptoms onset of left hemiplegia, left hemi anesthesia and right gaze deviation.
  • NIHSS = 22
  • CT scan at admission: ASPECTscore 10
  • Angio-CT: right proximal M2 occlusions
  • rTPA started 1h after onset
  • Patient transferred to thrombectomy center

   

  

  Thrombectomy setup

  • Procedure started 2h after symptoms onset
  • General anesthesia (intubation)
  • Right femoral artery puncture (8 French short sheaths)
  • NeuronMax 088
  • Sofia Plus 6 French
  • Marksmann
  • Wire Traxcess 14
  • Solitaire™ X 4x40mm (2 times)
  • Solitaire™ X 3x40mm

   

  

  

  

   

   

  

  

   

   

  

  

   

• Results
  • M2 recanalization: tici 3
  • NIHSS=14 after 3 days (persistent hemiplegia and hemianopsia)
  • Patient transferred to revalidation center

   

  This case is sponsored by Medtronic.