Rapid Recanalization Using TrevoProVue through a 4.2 Fr Catheter without a Guiding Catheter via Transbrachial Approach: A Case Report

• Yamaguchi Susumu

  Department of Neurosurgery, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Nagasaki, Japan Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Nagasaki, Japan

• Horie Nobutaka

  Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Nagasaki, Japan

• Morofuji Yoichi

  Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Nagasaki, Japan

• Satoh Kei

  Department of Neurosurgery, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Nagasaki, Japan

• Suyama Kazuhiko

  Department of Neurosurgery, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Nagasaki, Japan

Abstract

Mechanical thrombectomy with a stent retriever has been reported to achieve high rates of successful recanalization, and reduce disability and mortality in patients with acute ischemic stroke (AIS) due to proximal vessel occlusion. However, in a few cases, the treatment is difficult due to artery tortuosity or other factors. The authors present a case of a 94-year-old man presenting with acute right middle cerebral artery occlusion. We attempted to treat using a stent retriever via transfemoral approach, but failed to advance the guiding catheter into the right internal carotid artery due to femoral artery tortuosity and a type III arch. By changing approaches from transfemoral to transbrachial and by using TrevoProVue through a 4.2 Fr Simmons-type catheter without a guiding catheter, we were able to achieve rapid recanalization in only 26 minutes from brachial artery puncture to reperfusion. In conclusion, rapid reperfusion in an AIS patient was successfully achieved by combining a stent retriever with a 4.2 Fr catheter (without a guiding catheter) and a transbrachial approach (as opposed to a transfemoral approach). When the transfemoral approach is not feasible, we recommend consideration of this strategy as an alternative.

Journal

• NMC Case Report Journal

  NMC Case Report Journal 4 (4), 97-99, 2017

  The Japan Neurosurgical Society

Keywords

• acute ischemic stroke
• mechanical thrombectomy
• TrevoProVue
• transbrachial approach
• 4.2 Fr catheter

Details

• CRID: 1390001205742457728
• NII Article ID: 130006110899
• DOI: 10.2176/nmccrj.cr.2016-0235
• ISSN: 21884226
• Web Site: https://www.jstage.jst.go.jp/article/nmccrj/4/4/4_cr.2016-0235/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2018243921
• Text Lang: en
• Data Source:
  • JaLC
  • Crossref
  • CiNii Articles
  • KAKEN
• Abstract License Flag: Disallowed