Combined use of export catheter and penumbra vacuum thromboaspiration in a challenging case of acute common carotid artery occlusion

Rigatelli, Gianluca; Martire, Giuseppe; Gentile, Mauro; Michielan, F.; Amistà, Pietro

doi:10.1016/j.carrev.2016.05.012

Cited by 5 publications

(6 citation statements)

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“…First, even if successfully captured in the aspiration catheter, the large thrombus may occlude the guiding catheter or may be fragmented and cause embolism in the arteries of other organs during retrieval. 1 , 3 Piece-by-piece aspiration of a large thrombus may be effective, but recanalization takes more time. Second, in the case of CCA occlusion, ipsilateral cerebral blood flow is partially compensated by collateral pathways through the circle of Willis and the backflow of the ECA at the cervical carotid bifurcation.…”

Section: Discussionmentioning

confidence: 99%

“…Acute embolic occlusion of the common carotid artery (CCA) alone is rarely observed because most emboli pass through the CCA and reach the carotid bifurcation or intracranial internal carotid artery (ICA). [1][2][3] However, once it occurs, normal anterograde endovascular thrombectomy is not necessarily safe or effective, depending on the volume and stability of the emboli, hemodynamic status of the cerebral hemisphere, and remaining collateral pathways. For instance, catheter aspiration is less effective for massive emboli occupying long distances, and stent retrieval may cause distal migration of the emboli when crossing the lesion, which deteriorates cerebral perfusion by blocking residual collateral flow.…”

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confidence: 99%

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Retrograde thrombectomy of acute common carotid artery occlusion with mobile thrombus: illustrative cases

Okune,

Fukuda,

Matsuoka

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Acute embolic occlusion of the common carotid artery (CCA) alone is rare. However, once it occurs, recanalization is challenging due to the large volume of the clot, larger diameter of the CCA, and risk of procedure-related distal embolism into the intracranial arteries. OBSERVATIONS The authors report two cases of acute embolic occlusion of CCA alone, caused by a cardiac embolus trapped at the proximal end of a preexisting atherosclerotic plaque at the cervical carotid bifurcation. In both cases, the CCA was successfully recanalized using retrograde thrombectomy in a hybrid operating room. In case 1, a 78-year-old male with acute right CCA occlusion underwent retrograde thrombectomy, where the cervical carotid bifurcation was exposed and incised, and the entire embolus was retrieved with forceps. Despite successful revascularization, massive bleeding from the CCA just after the retrieval remained a concern. In case 2, a 79-year-old female with acute right CCA occlusion underwent retrograde thrombectomy in the same manner. Because manual retrieval failed, a Fogarty balloon catheter inserted from the arteriotomy successfully retrieved the entire thrombus with minimal blood loss. LESSONS Retrograde thrombectomy through the arteriotomy of the cervical carotid bifurcation safely and effectively recanalizes acute embolic occlusion of the CCA alone.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Retrograde thrombectomy of acute common carotid artery occlusion with mobile thrombus: illustrative cases

Okune,

Fukuda,

Matsuoka

et al. 2024

Journal of Neurosurgery: Case Lessons

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“…If these aspiration efforts fail to remove a sufficient clot amount, the thrombus may be unexpectedly hard, and the application of a combination technique using a stent or double-stent technique may be required. 18,29,31) In the presence of sheath occlusion, we recommend placing another sheath in the contralateral femoral artery and thereafter acquiring an angiogram to ascertain the absence of a thrombus around the first sheath. When a clot is observed, thrombectomy in that sheath or direct removal of the thrombus may be required to prevent critical femoral artery occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…12) Thrombi extending into the common carotid artery (CCA) territory are rare. [16][17][18] In patients with CCA occlusion, successful recanalization by the usual MT method may be difficult because the vessel is wide and the thrombus can be large. We report our endovascular procedure and the clinical outcome in seven patients whose CCA occlusions were addressed by MT.…”

Section: Introductionmentioning

confidence: 99%

Mechanical Thrombectomy for Acute Common Carotid Artery Occlusion

Ideguchi

Kim

Suzuki³

et al. 2023

Neurol. Med. Chir.(Tokyo)

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Mechanical thrombectomy (MT) is the standard treatment for acute large occlusion of the cerebral artery. Evidence for the success of this procedure was based on the treatment of patients with internal carotid artery and middle cerebral artery thrombi. There are a few reports on thrombi extending to the common carotid artery (CCA). We document our endovascular procedure and the clinical outcome in seven consecutive patients who underwent MT for CCA thrombi between September 2016 and April 2021. Their mean National Institutes of Health Stroke Scale score was 20.0 (range, 9-30), and the mean diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score on magnetic resonance images was 8.7 (range, 7-10). In six patients, MT of the CCA occlusion was successful, and the mean puncture-to-reperfusion time was 84 minutes (range, 39-211 minutes). In five patients, successful reperfusion was obtained. The mean total pass number was 4.1 (range, 2-7). Due to large thrombi, we performed balloon guide catheter (BGC) occlusion in three patients. Sheath occlusion occurred in two, and thrombus migration into the femoral artery around the sheath was observed in two patients. The mean modified Rankin Scale score 3 months post-stroke was 3.6 (range, 2-5). When the removal of a large CCA thrombus is attempted in a single step, catheter and sheath occlusion may occur, and this increases the risk for critical systemic artery occlusion. Therefore, we suggest that MT be combined with the BGC technique and propose the use of a large aspiration catheter to decrease the volume of the thrombus.

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“…Specifically, the role for CAT has been identified as a treatment for PE, lower extremity arterial occlusions, carotid occlusions, iliocaval thromboses, right atrial thromboses, mesenteric thromboses, as well as aspiration of vegetations on implanted cardiac leads or valves. [1,2,[10][11][12][13][14] Given its potential to evacuate thrombus and prevent recurrent subclinical pulmonary emboli, CAT may represent a method to treat thrombosed dialysis access shunts. Currently, however, the role of CAT for restoring patency in dialysis access has not been clearly defined.…”

Section: Introductionmentioning

confidence: 99%

Continuous Aspiration Mechanical Thrombectomy for Treatment of Thrombosed Hemodialysis ReliableOutflow Grafts

Ahmed

Hadied

Madassery

et al. 2020

The Arab Journal of Interventional Radiology

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Aims: To determine the safety and feasibility of continuous aspiration mechanical thrombectomy (CAT) for restoring patency to thrombosed hemodialysis reliable outflow (HeRO) arteriovenous grafts. Subjects and Methods: Between December 2016 and August 2017, eleven consecutive patients (average age 63, range 39–80 years) with thrombosed HeRO grafts underwent percutaneous thrombectomy procedures (n = 21) using the Penumbra Indigo ® CAT 8 or CAT D (Alameda, CA, USA) thrombectomy catheter as the primary device to clear the venous outflow tract before removing the arterial plug with a compliant balloon. A total of 21 hemodialysis declot procedures using CAT were documented and analyzed. Average procedure length and fluoroscopy time, length of thrombus cleared, blood loss, complications, and time between thrombectomy procedures were recorded and compared to the same patient's previous three thrombectomy procedures. Results: All procedures were technically successful (100%) at restoring graft patency; however, reocclusion within 5 days occurred in four (19.0%) cases. Three (14.3%) interventions required additional balloon maceration or sweep to clear the venous outflow following thrombectomy. Average thrombus length treated by suction thrombectomy measured 23.15 cm (range 2.2–65 cm). Average blood loss was 162.6 mL (range 50–250 mL). No procedure-related complications were recorded. The average procedure length and fluoroscopy time using suction thrombectomy was 74.7 and 14.2 min, respectively, compared with 82.0 and 14.0 min, respectively, in the previous thrombectomy procedures using standard methods (P > 0.05). Seventeen (81%) HeRO grafts treated by CAT presented with rethrombosis at a mean of 42.47 days (range 1–208 days, median 22 days, standard deviation [SD] 28.2 days) since CAT procedure compared to patients treated by conventional methods who presented for rethrombosis at a mean of 55.33 days (range 1–321 days, median 34 days, SD 43.1 days) since standard thrombectomy – no statically significant difference (P > 0.05). Conclusion: CAT is a safe and feasible method for removing thrombus and restoring patency to thrombosed HeRO grafts. Further studies are required to elucidate the advantages of CAT over standard thrombectomy techniques.

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Combined use of export catheter and penumbra vacuum thromboaspiration in a challenging case of acute common carotid artery occlusion

Cited by 5 publications

References 0 publications

Retrograde thrombectomy of acute common carotid artery occlusion with mobile thrombus: illustrative cases

Retrograde thrombectomy of acute common carotid artery occlusion with mobile thrombus: illustrative cases

Mechanical Thrombectomy for Acute Common Carotid Artery Occlusion

Continuous Aspiration Mechanical Thrombectomy for Treatment of Thrombosed Hemodialysis ReliableOutflow Grafts

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