J Cerebrovasc Endovasc Neurosurg.  2024 Dec;26(4):418-423. 10.7461/jcen.2024.E2023.08.006.

Novel use of a stent retriever as a distal filler protection device for prevention of secondary embolization

• Iijima S
• Imaoka Y
• Iihoshi S
• Kohyama S

• KMID: 2563092
• DOI: http://doi.org/10.7461/jcen.2024.E2023.08.006

Abstract

Distal embolus due to mechanical thrombectomy is a frequent complication and directly results in a poor prognosis. Therefore, it is important to decrease distal embolus as much as possible in mechanical thrombectomy. EmboTrap III may be useful as a filter to prevent distal embolus in patients with a large volume of thrombus. Here, we report the results of one suggestive case and we also provide experimental data from a vessel model. The patient was a 78-year-old female who was admitted to hospital as an emergency case with chief complaints including dysarthria and left hemiplegia, including facial paralysis. She was diagnosed as large vessel occlusion-acute ischemic stroke with right tandem lesions by workup and underwent mechanical thrombectomy. A large volume of secondary thrombus due to flow stasis was assumed based around the occlusion site, and worsening of neurological symptoms was a concern due to distal embolus caused by recanalization of the cervical internal carotid artery. The SEIMLESS technique was performed under distal protection using EmboTrap III. There was no distal embolus or deterioration of neurological symptoms, and a good prognosis was achieved. This outcome suggests that PTA under distal protection using EmboTrap III may be useful for prevention of distal embolus.

Keyword

Embolic Protection Devices; EmboTrap III; Percutaneous transluminal angioplasty; Thrombectomy

Figure

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  Fig. 1. Brain diffusion-weighted MRI (A) and MRA (B) on arrival. Acute cerebral infarction was found from the right temporal to parietal lobes. MRA showed occlusion in the right internal carotid artery and middle cerebral artery. MRI, magnetic resonance imaging; MRA, magnetic resonance angiography

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  Fig. 2. The internal carotid artery was occluded immediately after the division (black arrow). Cerebral angiography before MT. The internal carotid artery was occluded immediately after the division and the middle cerebral artery was also occluded from the horizontal site (A, B). MT, mechanical thrombectomy

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  Fig. 3. PTA was conducted after EmboTrap was expanded from the middle cerebral artery to the internal carotid artery as a distal protection device. PTA, percutaneous transluminal angioplasty

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  Fig. 4. Cerebral angiography after MT. Recanalization was confirmed in all arteries other than the parieto-occipital artery, and no marked distal embolus was found. Thrombolysis in cerebral infarction 2b was recanalized (A, B). MT, mechanical thrombectomy

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  Fig. 5. A blood vessel prosthesis model and pseudo-thrombus were produced and Solitaire (6×40 mm), Trevo NXT (6×37 mm) and EmboTrap (6.5×40 mm) were assessed as distal protection devices. The thrombus was cleaved into 10 fragments, the pump was started at a flow rate of 60 mL/sec and a pulse of 60 bpm, and the number of thrombotic segments captured by the SR was assessed. The numbers of captured thrombi were 1/10 by Solitaire (A), 0/10 by Trevo (B) and 9/10 by EmboTrap III (C, D).

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