Triple Stentriever “Bouquet” Deployment with Zoom 88 Large-Bore Aspiration and Walrus Balloon-Guide Catheter for the Definitive Thrombectomy of a Carotid Free-Floating Thrombus

Author:

Campos Jessica K.1,Meyer Benjamen M.2,Khan Muhammad W.3,Zarrin David A.4,Beaufort Jonathan C. Collard de5,Amin Gizal3,Lin Li-Mei3,Coon Alexander L.3

Affiliation:

1. Department of Neurological Surgery, University of California Irvine, Orange, California, United States

2. University of Arizona, College of Medicine, Tucson, Arizona, United States

3. Department of Neurological Surgery, Carondelet Neurological Institute, St. Joseph's Hospital, Tucson, Arizona, United States

4. Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, United States

5. College of Arts and Science, Syracuse University, Syracuse, New York, United States

Abstract

AbstractFormation of a carotid free-floating thrombus (CFFT) is a rare and life-threatening condition without an optimal management plan. A 78-year-old woman with a history of prior right internal carotid artery (ICA) mechanical thrombectomy and antiplatelet noncompliance presented with transient ischemic attacks secondary to a recurrent CFFT in the right ICA. Given her symptoms and recurrent CFFT, endovascular mechanical thrombectomy was performed. A balloon guide-catheter (BGC) and a Zoom 88 distal access catheter were brought into the right distal common carotid artery and proximal ICA bulb, respectively. Three 0.021-inch microcatheters, each loaded with a unique stentriever, were navigated beyond the thrombus into the upper cervical ICA and deployed in a bouquet fashion. The BGC was inflated to achieve flow arrest, and the Zoom 88 aspiration catheter was tracked over the three bouquet stentrievers to ingest the thrombus. Follow-up angiography demonstrated recanalization of the proximal cervical ICA without evidence of residual thrombus. Twenty-four-hour postoperative computed tomography imaging did not reveal any evidence of new infarction. The patient was discharged home with an intact neurological examination, compliant on aspirin and apixaban. We demonstrate a novel technique utilizing a large-bore catheter with a triple stentriever “bouquet” to thrombectomize a CFFT.

Publisher

Georg Thieme Verlag KG

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