J Cerebrovasc Endovasc Neurosurg.  2024 Sep;26(3):311-317. 10.7461/jcen.2024.E2023.11.002.

Suction thrombectomy of distal medium vessel occlusion using microcatheter during mechanical thrombectomy for acute ischemic stroke: A case series

• Jeong EO
• Kwon HJ
• Jeong H
• Lee HJ
• Kim KH
• Koh HS

• KMID: 2559442
• DOI: http://doi.org/10.7461/jcen.2024.E2023.11.002

Abstract

While mechanical thrombectomy is known to be effective for distal medium vessel occlusion (DMVO) as well as large vessel occlusion, tortuous DMVO are predisposed to vessel injury during stent retriever thrombectomy. Furthermore, getting access to the thrombus may be difficult during suction thrombectomy using a dedicated suction catheter. Most studies describe DMVO treatment using stent retrievers and dedicated suction catheters, but there are limited studies reporting DMVO treated with suction thrombectomy using a microcatheter. Herein, we describe three cases of DMVO treated with suction thrombectomy that was performed using a microcatheter and subsequently showed good results. Therefore, suction thrombectomy using a microcatheter is a viable alternative treatment for tortuous DMVO.

Keyword

Thrombectomy; Suction; Cerebrovascular occlusion

Figure

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  Fig. 1. Case 1. (A) Initial angiogram showing concurrent middle cerebral artery and distal anterior cerebral artery (arrow) occlusions. (B) After intra-arterial thrombectomy for M1 occlusion with Penumbra 5Max, distal anterior cerebral artery occlusion remained (arrow). (C) Angiogram following suction thrombectomy for distal anterior cerebral artery occlusion with Excelsior XT-27 microcatheter (Stryker, USA) showing near complete recanalization of previous occlusions. (D) Photograph of the tip of Excelsior XT-27 microcatheter which is attached to the thrombus. Note that the very distal part of the microcatheter lumen is filled by thrombus (arrow).

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  Fig. 2. Case 2. (A) Initial right vertebral artery angiography showing intact distal arteries while no visualization of distal left vertebral artery is noted (arrow). (B) Left distal posterior cerebral artery occlusion (arrow) is noted on follow-up left vertebral artery angiogram after suction thrombectomy to distal left vertebral artery. Previously occluded left posterior inferior cerebellar artery is now intact after thrombectomy. (C) Forward movement of the Marksman microcatheter (Medtronic, USA) tip (arrow) is noted at the end of the distal posterior cerebral artery thrombectomy using Marksman microcatheter. (D) Photograph of the tip of the Marksman microcatheter with an attached thrombus. Note that the very distal part of the microcatheter lumen is filled by thrombus (arrow).

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  Fig. 3. Case 3. (A) Initial angiogram showing concurrent right distal posterior cerebral artery (complete, arrow) and left superior cerebellar artery (incomplete, star) occlusions. (B) Roadmap image showing Marksman microcatheter (Medtronic, USA) (arrow) approaching the thrombus for distal posterior cerebral artery occlusion inside the intermediate catheter (star). (C) Angiogram after microcatheter suction showing complete recanalization of the right posterior cerebral artery. Left superior cerebellar artery occlusion was recanalized with Solitaire Prime with Prowler Select plus microcatheter thereafter. Acute angulation of left superior cerebellar artery hindered approaching of the Marksman microcatheter to the distal occlusion site. (D) Photograph of the tip of the Marksman microcatheter with the thrombus attached. Note that the very distal part of the microcatheter lumen is filled by thrombus (arrow)

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