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Extensive thrombus burden: Using the right material in the right situation leads to success

Last update on July 3, 2025

Author:  SCHULZ Katharina

 

Strategic use of a large aspiration catheter (React71) for the ICA and a stent retriever (Solitaire) for the MCA ensured successful recanalization in a complex thrombus scenario.

Patient situation

An 84-year-old woman presented with complete right middle cerebral artery syndrome (NIHSS 19) for 1 hour.

  • Global aphasia
  • Right-sided hemiparesis
  • Turning gaze to the left

The patient had arterial hypertension, with no other pre-existing conditions.
The ECG on admission revealed atrial fibrillation.

 

The CCT showed an extensive hyperdense vessel in the M1 segment, while the CTA confirmed a proximal M1 occlusion along with a proximal thromboembolic occlusion of the left ICA.

The CT scan also revealed an old infarct in the right middle cerebral artery territory.

   

CT perfusion indicated a large penumbra in the left hemisphere with a small infarct core at the level of the basal ganglia.

 

Treatment chosen

Set up:

  • No thrombolytic therapy due to early infarct demarcation
  • General anaesthesia
  • Right femoral artery puncture (8-French short sheath)
  • NeuronMAX long sheath
  • 0.014” TransendEX Microwire

ICA occlusion:

  • React71 Aspiration Catheter

M1 occlusion:

  • 6F Sofia Distal Access Catheter
  • Headway21 Microcatheter
  • Solitaire 4 mm x 40 mm Stent Retriever

 

Aspiration

ICA occlusion

  • The long sheath was positioned in the common carotid artery.
  • A large-bore aspiration catheter (React71) was used to recanalize the internal carotid artery through three aspiration manoeuvres, addressing the extensive thrombus burden.

  

 

Stent Retriever

M1 occlusion

A stent retriever was selected due to the long-segment thrombus in the M1 segment. After confirming the position with the microcatheter, the stent retriever (Solitaire 4 mm x 40 mm) was deployed in the M1 segment. Mechanical thrombectomy was then performed with distal aspiration, resulting in complete recanalization of the left MCA territory (first-pass).

  

Results

Outcome

Given the extensive thrombus burden and newly diagnosed atrial fibrillation, the patient was initiated on a heparin infusion immediately after thrombectomy, followed by Clexane therapy.

At discharge after 11 days, the patient had a residual mild facial paresis, with no other neurological deficits detected.

  • NIHSS 19 at admission
  • NIHSS 5 after 48h
  • NIHSS 1/mRS 1 at discharge

CCT before discharge

  

Supported by Medtronic

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