Middle Cerebral Artery (MCA) embolectomy using CerebrAX / FlexTake stent retriever
Surgeon's profile

Dr Ding Cha Wen
Chonggang General Hospital
- Deputy Director of Neurology and Comprehensive Interventions
- Member of Brain Disease Branch of the Chinese Academy of Gerontology and Gerontology
- Standing Committee of the Brain Vascular Intervention and Emergency Interventions Branch of the Chongqing Stroke Society
- Standing Member of the Division of Neurology of the Chongqing Physicians Association
- Member of the Youth Committee of the Stroke Society of Chongqing
- Member of Chapter of Neuroimmunology of the Southwest Stroke Society
- Member of The Chapter of Interventional Medicine of the Association of Social Medical Institutions of Chongqing
Awarded the title “Expert in the prevention and treatment of cerebrovascular disease” in Chongqing.
Specializes in emergency and elective interventional surgery for ischemic cerebrovascular disease and in interventional surgical treatment for peripheral vascular disease.
Studied neuro-interventional surgery at Newbridge Hospital, affiliated with the Army Medical College.
Published several papers.
Case information
Chief Complaint: 63 year old woman, non-speech and weakness in right limb for 4 hours..
Current Medical Condition: 4 hours before admission, her family noticed that she was unable to speak, had impaired hearing and understanding, had no movement of the right side of her body, and had an askew mouth. Unconscious disorder, limb twitching, intermittent wheezing, no vomiting, fearless cold, wheezed and wheezy, a few coughs and sputum, persistent symptoms. Emergency admittance into our hospital.
Past Medical History: Hypertension, diabetes mellitus for more than 7 years, no regular medication. History of lower limb deep vein thrombosis 6 yrs ago, which improved after treatment.
Physical Examination on Admission: Temperature 36.9 ° C P: 104 / d R: 19 / d BP: 182 / 100 mmHg. Both lungs exhibited crackling sounds with fluid accumulation, heart rhythm was regular, and valve auscultation revealed no irregularities. The abdomen was soft with no tenderness, and there was no pain upon palpation of the abdominal area. Lower extremities were without signs of edema.
Neurological examination: Revealed somnolence and mixed aphasia. Partial body coordination, with symmetric bilateral frontal striations present. Eyes were deviated to the left, with pupils equal in size (0.3 cm in diameter), round, and reactive to light. No nystagmus observed. Right nasolabial fold was shallow, and no cervical obstruction. Muscle strength graded 0 on right side and 5 on left side. Physical examination findings were inconclusive, and a positive Babinski sign was noted on the right.
NIHSS score: 21 points (consciousness 1, questioning 2, command 2, gaze 1, facial paralysis 2, left upper limb movement 4, left lower limb movement 4, language 3, articulation 2).
mRS Rating: 0 points.
ECG: sinus tachycardia, ST segment low pressure.
Random finger blood sugar: 10.5 mmol / L.
Preoperative imaging and diagnosis





Diagnosis
1. Acute cerebral infarction
2. LM2 upper stem initiation occlusion
3. High Blood Pressure Grade 3 (Very High Risk)
4. Type-2 diabetes mellitus
Diagnosis and treatment strategies
1. The patient experienced a stroke while conscious, with MRI findings showing positive diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR). Administration of rTPA was less beneficial. Clinical symptoms were severe, with an NIHSS score of 21. The infarct core was small (NCCT: ASPECTS score of 8), and there was moderate vascular occlusion at the origin of the upper trunk of LM2.
2. The benefit of emergency endovascular treatment in patients with acute moderate vascular occlusion remains uncertain. After careful screening and assessing the risk-benefit ratio, emergency endovascular treatment may offer a better treatment option. However, further evidence from randomized trials is required (Class IIb recommendation, Level B)*.
3. The family members opted for intravascular treatment after providing informed consent.
*Chinese guidelines for endovascular treatment of acute ischemic stroke 2023 [J].Chinese Journal of Stroke, 2023, 18 (06): 684-711.
Preoperative Images


Operation Procedure









Post Operative Images

Discharged after 2 weeks hospitalization
Neurological assessment: The patient is alert with clear speech and able to answer basic questions. Memory and numeracy are slightly impaired. Bilateral pupils are round, approximately 3 mm in diameter, and reactive to light. Eye movements are intact in all directions, with no nystagmus. Right-sided central paralysis observed. Tongue protrudes symmetrically. Limb strength is graded 4+ on the right and 5 on the left. Babinski sign is absent.
NIHSS score: 1 (facial paralysis 1)
Guidelines for medications upon discharge
Aspirin enteric-coated tablets 100mg once daily, Atorvastatin calcium tablets 20mg at night, Amlodipine Besylate tablets 2.5mg once daily, Metformin tablets 515mg twice daily, Dapagliflozin tablets 10mg once daily, Butylphthalide soft capsules 0.2g as prescribed.
Case Summary
1. Case characteristics:
- An elderly woman who experienced a stroke upon waking.
- The clinical symptoms are severe, the infarct core is small, vascular occlusion is moderate, and the surgical risk is high.
- The risk of damage and bleeding is high following vessel reperfusion.
2. Preoperative evaluation:
- Preoperative evaluation: Emergency CTA and MRI of the head and neck to rule out cerebral hemorrhage, assess the aortic arch and cervical vascular conditions, identify the occlusion site, and determine the infarcted area, in order to evaluate the surgical risk.
- Preoperative evaluation: Optimize blood routine, coagulation profile, and blood transfusion if necessary. Perform ECG, chest CT, and address any surgical contraindications.
3. Surgical technique highlights:
- Based on preoperative CTA and intraoperative DSA, evaluate the surgical approach and strategically plan the procedure;
- SWIM technology helps minimize the risk of thrombus dislodgement and enhances the recanalization rate.
- In the application of the SWIM technique, the suction tube is positioned to make maximum contact with the thrombus, enhancing the suction effect. The stent retrieval is slow and continuous, which helps reduce the risk of thrombus dislodgement and improves the recanalization rate.
4. Device usage advice: For patients with tortuous vessels, the CerebrAX/FlexTake stent retriever offers balanced radial support and flexibility, ensuring excellent delivery performance and strong clot retrieval capability. It provides a higher hand reflux rate, reducing the risk of clot dislodgement.
The Product


About Hemo
Hemo Biotechnology Co., Ltd. (referred to as “Hemo”) officially commenced operations in 2017. Hemo’s global headquarters is in Singapore, with research and development centers in both Singapore and China. It collaborates with long-term partners in the United States to focus on new product design and keep abreast of cutting-edge global technologies.
Hemo is dedicated to integrating high-quality global research and development, production, clinical, and academic resources to provide innovative vascular and neurointerventional products for patients and medical professionals. It aims to offer comprehensive intervention solutions for cerebrovascular diseases, including ischemic stroke, hemorrhagic stroke, and intracranial vascular stenosis.