Embolic protection devices and the Penumbra 054 catheter: Utility in tandem occlusions in acute ischemic stroke

Ferdinand Hui, Muhammad S. Hussain, Mohamed H. Elgabaly, Thinesh Sivapatham, Irene L. Katzan, Alejandro M. Spiotta

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)50-53
Number of pages4
JournalJournal of NeuroInterventional Surgery
Volume3
Issue number1
DOIs
StatePublished - Mar 2011
Externally publishedYes

Fingerprint

Embolic Protection Devices
Catheters
Stroke
Angioplasty
Conscious Sedation
Emergency Treatment
Middle Cerebral Artery Infarction
Middle Cerebral Artery
Neurologic Examination
Internal Carotid Artery
Angiography
Emergencies
Thrombosis
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Embolic protection devices and the Penumbra 054 catheter : Utility in tandem occlusions in acute ischemic stroke. / Hui, Ferdinand; Hussain, Muhammad S.; Elgabaly, Mohamed H.; Sivapatham, Thinesh; Katzan, Irene L.; Spiotta, Alejandro M.

In: Journal of NeuroInterventional Surgery, Vol. 3, No. 1, 03.2011, p. 50-53.

Research output: Contribution to journalArticle

Hui, Ferdinand ; Hussain, Muhammad S. ; Elgabaly, Mohamed H. ; Sivapatham, Thinesh ; Katzan, Irene L. ; Spiotta, Alejandro M. / Embolic protection devices and the Penumbra 054 catheter : Utility in tandem occlusions in acute ischemic stroke. In: Journal of NeuroInterventional Surgery. 2011 ; Vol. 3, No. 1. pp. 50-53.
@article{2ce523b3d1704d24a62f1d95fed5e7e7,
title = "Embolic protection devices and the Penumbra 054 catheter: Utility in tandem occlusions in acute ischemic stroke",
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.",
author = "Ferdinand Hui and Hussain, {Muhammad S.} and Elgabaly, {Mohamed H.} and Thinesh Sivapatham and Katzan, {Irene L.} and Spiotta, {Alejandro M.}",
year = "2011",
month = "3",
doi = "10.1136/jnis.2010.003012",
language = "English (US)",
volume = "3",
pages = "50--53",
journal = "Journal of NeuroInterventional Surgery",
issn = "1759-8478",
publisher = "BMJ Publishing Group",
number = "1",

}

TY - JOUR

T1 - Embolic protection devices and the Penumbra 054 catheter

T2 - Utility in tandem occlusions in acute ischemic stroke

AU - Hui, Ferdinand

AU - Hussain, Muhammad S.

AU - Elgabaly, Mohamed H.

AU - Sivapatham, Thinesh

AU - Katzan, Irene L.

AU - Spiotta, Alejandro M.

PY - 2011/3

Y1 - 2011/3

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=79954492397&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79954492397&partnerID=8YFLogxK

U2 - 10.1136/jnis.2010.003012

DO - 10.1136/jnis.2010.003012

M3 - Article

C2 - 21990789

AN - SCOPUS:79954492397

VL - 3

SP - 50

EP - 53

JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

IS - 1

ER -