We describe a case of acute middle cerebral artery occlusion in a patient with ipsilateral internal carotid artery dysgenesis successfully treated with mechanical thrombectomy utilising a collateral pathway. During the procedure, a triaxial system using a balloon guiding catheter, flexible large lumen aspiration catheter and stent retriever was advanced from the left vertebral artery to the occluded left middle cerebral artery through the left posterior communicating artery. Because proximal aspiration from the balloon guiding catheter alone might have insufficient suction force due to the retrograde blood flow from large vascular communications (e.g. vertebral artery union), the tip of the flexible large lumen aspiration catheter was set at the proximal left middle cerebral artery, and distal aspiration was added during stent retrieval. A thrombolysis in cerebral infarction 2b result was achieved after the first pass. In this case, identification of carotid canal hypoplasia on computed tomography allowed for an immediate attempt of this alternative approach, avoiding a delay in the time to reperfusion.
We have successfully developed a novel Package-on-Package (PoP) technology for achieving small package thickness and low package warpage. The novel package structure is based on an ultra-thin coreless substrate , called a Multi-Layer Thin Substrate (MLTS). The MLTS is fabricated by completely removing the Cu base plate after forming a high-density buildup structure on the base plate. In this paper, however, the Cu posts are formed by selective wet etching of the Cu base plate. Since the novel package has built-in Cu posts as external terminals, the overall substrate can be molded for the peripheral area as well as the chip mounting area. This paper also describes how two types of novel wet etching processes have been developed for obtaining narrower pitch and higher aspect ratio. Through the novel wet etching process , we achieve Cu posts of 0.5 mm pitch and high aspect ratio of 6.0, which cannot be realized by wet etching. A prototype package has 361 pads arranged in 5 rows with 0.5 mm pitch, and the thickness is only 0.23 mm.
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