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Campos JK, Meyer BM, Khan MW, Zarrin DA, Beaufort JCCD, Amin G, Lin LM, Coon AL. Triple Stentriever "Bouquet" Deployment with Zoom 88 Large-Bore Aspiration and Walrus Balloon-Guide Catheter for the Definitive Thrombectomy of a Carotid Free-Floating Thrombus. J Neurol Surg Rep 2024; 85:e17-e22. [PMID: 38348015 PMCID: PMC10861319 DOI: 10.1055/s-0044-1778695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/02/2023] [Indexed: 02/15/2024] Open
Abstract
Formation of a carotid free-floating thrombus (CFFT) is a rare and life-threatening condition without an optimal management plan. A 78-year-old woman with a history of prior right internal carotid artery (ICA) mechanical thrombectomy and antiplatelet noncompliance presented with transient ischemic attacks secondary to a recurrent CFFT in the right ICA. Given her symptoms and recurrent CFFT, endovascular mechanical thrombectomy was performed. A balloon guide-catheter (BGC) and a Zoom 88 distal access catheter were brought into the right distal common carotid artery and proximal ICA bulb, respectively. Three 0.021-inch microcatheters, each loaded with a unique stentriever, were navigated beyond the thrombus into the upper cervical ICA and deployed in a bouquet fashion. The BGC was inflated to achieve flow arrest, and the Zoom 88 aspiration catheter was tracked over the three bouquet stentrievers to ingest the thrombus. Follow-up angiography demonstrated recanalization of the proximal cervical ICA without evidence of residual thrombus. Twenty-four-hour postoperative computed tomography imaging did not reveal any evidence of new infarction. The patient was discharged home with an intact neurological examination, compliant on aspirin and apixaban. We demonstrate a novel technique utilizing a large-bore catheter with a triple stentriever "bouquet" to thrombectomize a CFFT.
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Affiliation(s)
- Jessica K. Campos
- Department of Neurological Surgery, University of California Irvine, Orange, California, United States
| | - Benjamen M. Meyer
- University of Arizona, College of Medicine, Tucson, Arizona, United States
| | - Muhammad W. Khan
- Department of Neurological Surgery, Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, Arizona, United States
| | - David A. Zarrin
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States
| | | | - Gizal Amin
- Department of Neurological Surgery, Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, Arizona, United States
| | - Li-Mei Lin
- Department of Neurological Surgery, Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, Arizona, United States
| | - Alexander L. Coon
- Department of Neurological Surgery, Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, Arizona, United States
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Lu J. Rescue of immediate post-transcarotid artery revascularization carotid stent thrombosis due to clopidogrel resistance using flow-reversal and aspiration thrombectomy. J Vasc Surg Cases Innov Tech 2023; 9:101205. [PMID: 37274441 PMCID: PMC10238582 DOI: 10.1016/j.jvscit.2023.101205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/14/2023] [Indexed: 06/06/2023] Open
Abstract
An 84-year-old patient developed immediate thrombosis of his carotid stent in recovery after transcarotid artery revascularization. In the present report, the technical details about intraoperative management for neurovascular rescue using the transcarotid artery revascularization flow-reversal system are described. The patient was determined to have clopidogrel resistance. Intraoperative medical management is also discussed. The current alternative intravenous and oral antiplatelet therapies such as glycoprotein IIb/IIIa and P2Y12 inhibitors are explored. The debate regarding preoperative antiplatelet resistance testing remains ambiguous, and increasing studies have demonstrated the safety and efficacy of alternatives to clopidogrel. Despite an unpredictable and devastating complication, the patient's outcome was successful using contemporary strategies.
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Affiliation(s)
- Joyce Lu
- Correspondence: Joyce Lu, MD, South Valley Vascular Associates, Division of BASS Medical Group, 820 S. Akers St., Suite 120, Visalia 93277, CA
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