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Rescue Forced-Suction Thrombectomy Using the Reperfusion Catheter of the Penumbra System for Thromboembolism During Coil Embolization of Ruptured Cerebral Aneurysms

Kang, Dong-Hun MD*,‡; Kim, Yong-Sun MD*; Park, Jaechan MD; Hwang, Yang-Ha MD§

doi: 10.1097/NEU.0b013e31822fefc4
Operative Technique

BACKGROUND: No definite conclusive management has been established in the treatment of thromboembolism during coil embolization of cerebral aneurysms. To date, intravenous heparin, intra-arterial fibrinolytic agent, and intravenous or intra-arterial glycoprotein IIb-IIIa inhibitors have been the mainstay of treatment. However, in practice, 2 major concerns may arise; first, recanalization is not always possible despite every effort of management; second, rehemorrhagic risk is increased if the event occurred during coiling of ruptured cerebral aneurysms.

OBJECTIVE: We introduce a new endovascular mechanical thrombectomy technique to overcome the aforementioned concerns.

METHODS: In 4 refractory cases involving conventional pharmaceutical treatment of thromboembolism during coiling, we practiced rescue suction thrombectomy using the reperfusion catheter of the Penumbra System.

RESULTS: All 4 of the patients to whom this technique was applied were successfully recanalized; 2 were Thrombolysis In Cerebral Infarction scale of 2b and the other 2 were a scale of 3. Recanalization was confirmed at the follow-up angiography at least 12 hours after the procedure. No complication associated with this technique occurred.

CONCLUSION: Forced-suction thrombectomy is a simple modification of the Penumbra System. Based on our preliminary data, this technique can play a role as an adjuvant management or as a last resort combined with injection of glycoprotein IIb-IIIa inhibitors in thromboembolic events that occur in coil embolization of a ruptured cerebral aneurysm.

*Department of Radiology, Daegu-Gyeongbuk Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea

Department of Neurosurgery, Daegu-Gyeongbuk Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea

§Department of Neurology, Daegu-Gyeongbuk Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea

Correspondence: Yong-Sun Kim, MD, Department of Radiology, Daegu-Gyeongbuk Cardiocerebovascular Center, Kyungpook National University Hospital, 50, Samduk-2-ga, Jung-gu, Daegu, 700-721 Republic of Korea. E-mail: kdhdock@hotmail.com

Received December 8, 2010

Accepted May 17, 2011

Copyright © by the Congress of Neurological Surgeons