Article Text

other Versions

PDF
Embolic protection devices and the Penumbra 054 catheter: utility in tandem occlusions in acute ischemic stroke
  1. Ferdinand K Hui,
  2. Muhammad S Hussain,
  3. Mohamed H Elgabaly,
  4. Thinesh Sivapatham,
  5. Irene L Katzan,
  6. Alejandro M Spiotta
  1. Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  1. Correspondence to Ferdinand K Hui, Cerebrovascular Center, Neurological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, S-80, Cleveland, OH 44195, USA; huif{at}ccf.org

Abstract

Background Tandem proximal and distal occlusions in the setting of an acute stroke are therapeutic challenges. Treating either lesion first has its respective shortcomings. An approach is described which may lessen the probability of distal embolic events during emergency carotid angioplasty and stenting during an acute stroke, and simplify access to both a distal and proximal lesion.

Clinical presentation A 58-year-old man presented with waxing and waning neurological examination with an NIH Stroke Scale varying from 4 to 21. CT angiography demonstrated a left internal carotid artery occlusion at its origin and a left middle cerebral artery occlusion. The CT scan failed to demonstrate significant ischemic changes so the patient was brought to angiography for treatment under conscious sedation.

Intervention Triaxial access into the distal middle cerebral artery was achieved followed by brief aspiration and clot maceration by opening the vessel completely. An embolic protection device was deployed through the intermediate catheter which was subsequently removed. Stenting and angioplasty were then performed, followed by removal of the embolic protection device which had visibly trapped debris.

Conclusion Embolic protection devices may have a role in the emergency treatment of proximal occlusions in the setting of an acute ischemic stroke. Safe deployment through an occluded vessel may be assisted by use of an intermediate catheter. The Penumbra 054 catheter may be used both to aspirate the distal thrombus and to house the embolic protection device as it is advanced past a proximal occlusion.

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Cleveland Clinic.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.