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Implementation of Penumbra-assisted half-stent thrombectomy for patients with acute M2 occlusion: results of initial experiences
Author(s): ,
A. Uyama
Affiliations:
Shin-suma Hospital, Department of Neurosurgery, Kobe, Japan
,
A. Fujita
Affiliations:
Kobe University Graduate School of Medicine, Department of Neurosurgery, Kobe, Japan
,
T. Kondoh
Affiliations:
Shin-suma Hospital, Department of Neurosurgery, Kobe, Japan
,
Y. Takaishi
Affiliations:
Shin-suma Hospital, Department of Neurosurgery, Kobe, Japan
,
A. Arai
Affiliations:
Shin-suma Hospital, Department of Neurosurgery, Kobe, Japan
,
S. Miyake
Affiliations:
Kita-harima Medical Center, Department of Neurosurgery, Ono, Japan
,
H. Hamaguchi
Affiliations:
Kita-harima Medical Center, Department of Neurology, Ono, Japan
E. Kohmura
Affiliations:
Kobe University Graduate School of Medicine, Department of Neurosurgery, Kobe, Japan
EANS Academy. Uyama A. Oct 21, 2018; 225879; EP1127
Atsushi Uyama
Atsushi Uyama
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Abstract
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Background: The benefits of mechanical thrombectomy (MT) for acute M2 occlusion have remained unclear because of unavoidable device-related complications due to vascular morphological characteristics. We developed Penumbra-assisted half-stent thrombectomy for achieving secure retrieval of thrombus with minimal damage to the small-caliber vessel.
Methods: A total of 6 patients were treated with MT for acute M2 occlusion using this technique between November 2016 and May 2017 including 3 men and 3 women; mean age 74.8 (51-98) years. Mean baseline National Institutes of Health Stroke Scale score was 17.5 (6-32), and Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score was 7.5 (6-9). After navigation of the microcatheter through the thrombus in M2 supported by a Penumbra 4MAX as a distal access catheter, the stent retriever (SR) was partially deployed to cover the entire thrombus. The 4MAX was then advanced toward the caudal end of the thrombus, and the SR was pulled back into the 4MAX with simultaneous aspiration of the 4MAX.
Results: We used the Trevo XP3 in 5 patients and ReVive SE in 1 patient. Mean procedure time from groin puncture to recanalization was 60 (54-66) min. Successful recanalization (Thrombolysis in Cerebral Infarction score 2b or 3) was achieved in 5 (83%) patients; there was no case of symptomatic intracranial hemorrhage. Good outcome (modified Rankin Scale score 0 to 2) at 3 months was achieved in 3 (50%) patients.
Conclusions: Penumbra-assisted half-stent thrombectomy seemed to be an effective alternative strategy in MT for acute M2 occlusion.
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