Neurointervention.  2020 Jun;15(2):89-95. 10.5469/neuroint.2020.00136.

Mechanical Thrombectomy for Large Vessel Occlusion via the Transbrachial Approach: Case Series

Affiliations
  • 1Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
  • 2Department of Neurosurgery, Shimizu Hospital, Kyoto, Kyoto, Japan

Abstract

Mechanical thrombectomy has become a standard treatment for acute ischemic stroke with large vessel occlusion. In aged patients, it is difficult to guide the catheter via the transfemoral approach due to vessel tortuosity and aortic elongation. We report our preliminary clinical experience using the transbrachial approach. Among the 119 patients who underwent thrombectomy from April 2018 to December 2019, a total of 5 patients were treated via the transbrachial approach. Clinical outcomes were retrospectively analyzed. Successful reperfusion was achieved in 4 out of 5 cases. There was 1 death due to symptomatic intracranial hemorrhage. One patient had a good outcome at discharge. There were no access-site complications associated with any of these cases. Transbrachial access for mechanical thrombectomy is feasible and can provide an alternative to the transfemoral approach.

Keyword

Transbrachial approach; Mechanical thrombectomy; Acute ischemic stroke

Figure

  • Fig. 1. Case 3. (A) This patient had a TypeⅢ aortic arch. (B) Right brachial artery angiogram obtained through a 4-Fr sheath. (C) The left carotid angiogram shows occlusion of the M2 portion of the left middle cerebral artery. (D) The tip of the microcatheter was advanced beyond the occluded lesion. (E) Thrombolysis as cerebral infarction (TICI) 3 reperfusion was achieved with combined Catalyst 6 (Stryker, Fremont, CA, USA) and EmbotrapⅡ (Johnson & Johnson, Raynham, MA, USA).

  • Fig. 2. Case 4. (A) The patient had a bovine arch, and the left common carotid artery was tortuous. (B) The left carotid angiogram shows occlusion of the M1 portion of the left middle cerebral artery. (C) The tip of the microcatheter was advanced beyond the occluded lesion. (D) Trevo XP Provue (Stryker, Kalamazoo, MI, USA) was passed and deployed. The arrowhead indicated the stent tip. (E) Digital subtraction angiography shows that M1 was occluded after thrombectomy using Trevo Xp Provue. (F) Thrombolysis as cerebral infarction (TICI) 2b reperfusion was achieved after thrombectomy using Sofia Flow Plus (MicroVention Terumo, Tustin, CA, USA).


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