Aspiration Thrombectomy of Acute Complete Carotid Bulb Occlusion

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Two patients with acute complete carotid bulb occlusion were treated using intra-arterial aspiration thrombectomy a mean of 3 hours after stroke onset. A slightly angulated 8-F guiding catheter designed for general interventional use was employed to aspirate the thrombus in the carotid artery. Manual aspiration through a 50-mL syringe resulted in effective removal of the thrombus followed by good patency of the internal carotid artery. Aspiration thrombectomy is a simple, feasible and effective rescue procedure for patients with acute complete carotid bulb occlusion.

Section snippets

Patient 1

A 72-year-old woman presented with right hemiparesis and aphasia of 4 hours duration. Her National Institutes of Health Stroke Scale (NIHSS) score was 17. Magnetic resonance (MR) for acute stroke, including diffusionweighted imaging (DWI), T2-weighted imaging, perfusion-weighted imaging (PWI) and three-dimensional time of flight intracranial arteriography (MRA), revealed a large DWI/PWI mismatch (PWI > DWI) in the left cerebral hemisphere and non-visualization of the left ICA. She had no

DISCUSSION

During acute thrombolytic attempts as those used in our two patients who presented with acute stroke, intra-arterial aspiration thrombectomy can be a rescue procedure to restore carotid arterial flow when there is a large thrombi burden at the level of the carotid bulb leading to complete occlusion. Although our study had a limited number of patients, the excellent angiographic results (TIMI 3) and good clinical recovery (NHISS score 4, 2 at the time of discharge; mRS score 2, 1 at 3 months)

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Cited by (0)

This study was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (03-PJ1-PG1-CH06–0001).

None of the authors has identified a potential conflict of interest.

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