Case Study
AsprAX / Afentta Aspiration Catheter and EmerAX / TracLine LDP Assisted Rapid Recanalization of Acute Vertebrobasilar Artery Occlusion + Angioplasty
Surgeon's Profile
Zhang Yongsen
Third Affiliated Hospital of Xinxiang Medical University
- Associate Chief Physician of Neurosurgery, Head of Neurointerventional Group in Neurosurgery Department, Master’s degree.
- Specializes in interventional treatment of intracranial aneurysms, intracranial arteriovenous malformations, arteriovenous fistulas, intracranial and extracranial vascular stenosis, and acute cerebral infarction stent thrombectomy. Also performs surgical treatment for cranial injury, cerebral hemorrhage, and intracranial tumors.
- Received the 5C certification from the Critical Care Medicine Branch of the Chinese Medical Association. Youth Member of the Neurointervention Committee of the Henan Medical Association, Member of the Neurointervention Committee of the Henan Stroke Association, and Youth Member of the Neurocritical Care Professional Committee of the Henan Stroke Association.
- Published more than 10 papers, 2 books, and holds 2 patents.
Lu Linya
Third Affiliated Hospital of Xinxiang Medical University
- Attending Physician of Neurosurgery, Master of Medicine, graduated from Xinxiang Medical University. Specializes in surgical treatment of common and frequently occurring neurological diseases such as cranial and cerebral trauma, hypertensive intracerebral hemorrhage, intracranial aneurysms, with a sub-specialty focus on neurointervention.
- Previously trained in the Neurointervention Department of Beijing Tiantan Hospital, skilled in the interventional and clinical diagnosis and treatment of intracranial aneurysms, cerebral infarction, cerebral vascular stenosis, and spinal cord vascular malformations.
Zhang Peng
Third Affiliated Hospital of Xinxiang Medical University
- Attending Physician of Neurosurgery, Master’s degree candidate, graduated from Xinxiang Medical University. Specializes in surgical treatment of common and frequently occurring neurological diseases such as cranial and cerebral trauma, hypertensive intracerebral hemorrhage, intracranial aneurysms.
- Subspecialty focus on cerebrovascular disease treatment. Completed further training in 2020 at Beijing Tiantan Hospital, skilled in the interventional and surgical treatment of intracranial aneurysms, cerebral infarction, cerebral vascular stenosis, and spinal cord vascular malformations. Obtained the qualification of Critical Care Medicine Specialty (5C certification) from the Critical Care Medicine Branch of the Chinese Medical Association.
Wang Long
Third Affiliated Hospital of Xinxiang Medical University
- Attending Physician of Neurosurgery, Master of Medicine. Studied under the renowned neurosurgery expert Professor Zhang Xinzhong from Henan Province. Graduated from Xinxiang Medical University. Published 4 papers in Chinese core journals and SCI journals, and participated in 1 municipal medical project.
- Currently specializing in cerebrovascular diseases, focusing on interventional and surgical treatments such as vascular anastomosis and bypass surgery. Received standardized training in neurosurgery microsurgery operations, with in-depth research on procedures like carotid endarterectomy and intracranial-to-intracranial and extracranial-to-intracranial cerebral vascular bypass surgery for cerebrovascular diseases. Also experienced in comprehensive treatment of common neurological diseases such as hypertensive intracerebral hemorrhage and cranial cerebral trauma.
Case Information
Chief Complaint: Weakness in the right limbs accompanied by speech impairment for over 5 hours, followed by a half-hour consciousness disorder.
Present Illness: About 5 hours ago, sudden onset of weakness in the right limbs, predominantly affecting the right upper limb, accompanied by speech impairment, dizziness, nausea, and vomiting once with gastric contents. No apparent consciousness disorder initially. Symptoms slightly improved after a few minutes but were not taken seriously and remained untreated. The above symptoms recurred several times. The patient arrived at emergency department about 1 hour ago, underwent a head CT scan, which showed no intracranial hemorrhage. They were urgently administered intravenous thrombolysis through the green channel. Half an hour before admission, the patient experienced sudden consciousness disorder. Repeated CT scan showed no secondary intracranial hemorrhage. Symptoms slightly improved after about ten minutes. Considering the urgent need for intervention to open the large intracranial vessels due to suspected acute cerebrovascular disease, the patient was transferred to our department. Since onset, the patient has been confused, with normal spirits, and has not consumed water.
Past History: Experienced transient right-sided limb weakness accompanied by aphasia 3 months ago, which was not taken seriously or treated, leaving no apparent sequelae. Blood pressure was found to be high over 3 months, with the highest reading of 145/90 mmHg, but the patient did not take any antihypertensive medication.
Physical Examination on Admission: Consciousness is vague; GCS score is 12 points; aphasia. NIHSS score is 15 points; the water swallow test cannot be completed; ADL score is 20; mRS score is 5 points; AIS-APS score is 10; both pupils are 3 mm, with normal light reflex, and unrestricted eye movements. Skin sensation: examination cannot be completed. Neck is supple; muscle strength of the left limbs is grade 4, and that of the right limbs is grade 1.
Diagnosis:
- Acute cerebral infarction
- Acute occlusion of the vertebrobasilar artery
- Hypertension
Preoperative Imaging
Surgical Procedure
DSA: Hemo 6F AsprAX / Afentta 065-127 aspiration catheter angiography exhibits first-pass effect, considering ICAS lesions, prepare for direct aspiration
Postoperative Imaging
Case Summary
1. Case Characteristics: Based on the patient’s medical history, ICAS lesions were suspected. Intraoperatively, the first-pass effect confirmed tandem stenosis of the vertebral basilar artery. Hemo’s 6F 065-127 aspiration catheter was used to aspirate and recanalize the vertebral basilar artery. Tandem stenosis was treated with balloon dilatation and stent placement.
2. Preoperative Assessment: The patient had an acute onset, and considering the medical history and clinical symptoms, ICAS lesions were suspected. Preoperative MRI showed pons infarction with an ASPECTS score of 8. Preoperative MRA indicated acute occlusion of the vertebral basilar artery, with poor compensation from the posterior circulation, meeting the indications for acute thrombectomy surgery.
3. Surgical Technique: Intraoperatively, the micro-guidewire and micro-catheter confirmed the first-pass effect, consistent with preoperative assessments. Stent retrieval was not used. Instead, direct aspiration was performed using a suction catheter.
4. Instrument Usage Techniques: The design of Hemo’s 8F EmerAX / TracLine LDP (large-bore distal access platform) 088 intermediate catheter allowed for optimal placement due to its gradual transition segment at the distal end, easily reaching C4, V3, and the confluence of the sinuses via the sigmoid sinus. The stable support provided by the remaining support parts ensured smooth and ample compatibility with other instruments, allowing for efficient and unhurried operation. The excellent maneuverability of Hemo’s 6F 065-127 aspiration catheter ensured swift positioning, while the increased contact area of the tapered tip enhanced suction efficiency. The perfect coordination between these instruments was crucial for the rapid recanalization of the occlusion.
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