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, two 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 four 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 four of the patients to whom this technique was applied were successfully recanalized; two were Thrombolysis In Cerebral Infarction scale of 2b and the other two were of 3. Recanalization was confirmed at the follow-up angiography at least 12 hours from 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 a last resort combined with injection of glycoprotein IIb-IIIa inhibitors in thromboembolic events that occur in coil embolization of a ruptured cerebral aneurysm.
Copyright (C) by the Congress of Neurological Surgeons