Article Figures & Data
Figures
- Fig 1.
Photograph of the basket-type microsnare (Soutenir, 5 mm) after deployment through the 2.3F microcatheter. The fully extended basket of the microsnare is 5 mm in diameter when the microsnare is protruded completely from the microcatheter (A) and is closed appropriately when partially withdrawn into the microcatheter (B).
- Fig 2.
Anteroposterior left carotid angiograms in case 7. A, Angiogram obtained before the procedure showing total occlusion of the left internal carotid artery (ICA). B, Angiogram obtained during the procedure demonstrating the microsnare (In-Time, arrow) and proximal ICA blockade by inflation of the coaxial balloon (arrowheads). C and D, Angiograms obtained immediately after the procedure showing complete recanalization of the ICA, without distal embolization. Some branches of the MCA do not fill, and filling of the MCA is slow compared with that of the anterior cerebral artery (D).
- Fig 3.
Macroscopic photograph showing the 4 clots retrieved in case 7. The extent of the longest clot is >7 cm.
Tables
Patient No./ Sex/Age (y) Clinical Symptoms on Admission NIHSS Score on Admission Treatment before Procedure Onset-to-Procedure Time (min) Embolic Risk Factor 1/M/82 Somnolence, TA, CD, HP 18 None 116 AF 2/M/81 Somnolence, AG, HP 21 None 349 AF 3/M/91 Stupor, AG, CD, HP 19 None 209 AF 4/F/78 Coma, TA, QP 26 None 120 AF 5/M/88 Somnolence, AG, CD, HP 17 None 173 AF 6/M/88 Coma, TA, HP 24 None 137 AF 7/F/87 Somnolence, TA, CD, HP 22 None 223 AF 8/M/78 Stupor, AG, CD, HP 19 Warfarin 230 AF 9/M/64 Somnolence, AG, HP 14 Aspirin 152 AF 10/F/32 Stupor, TA, CD, HP 24 Heparin + warfarin 123 DCM 11/M/73 Somnolence, TA, CD, HP 18 Heparin + warfarin 98 AF 12/F/81 Somnolence, TA, CD, HP 21 None 193 AF 13/F/69 Somnolence, TA, HP 17 None 310 AF 14/F/73 Somnolence, AG, CD, HP 21 Aspirin 195 AF Note:—NIHSS indicates National Institutes of Health Stroke Scale; TA, total aphasia; HP, hemiplegia/hemiparesis; AG, agnosia; CD, conjugate deviation of the eyes; QP, quadriparesis; AF, atrial fibrillation; DCM, dilated cardiomyopathy.
Patient No./Sex/Age (y) Side of Lesion High Signal Intensity on DWI Delay in MTT Relative CBV Diffusion/Perfusion Mismatch 1/M/82 L CF, BG Small abnormality Yes Large signal intensity loss Large 2/M/81 R BG Small abnormality Yes Small signal intensity loss Small 3/M/91 R CF, BG Small abnormality Yes Small signal intensity loss Small 4/F/78 L IC Small abnormality Yes Large signal intensity loss Large 5/M/88 R CF, IC, BG Small abnormality Yes Large signal intensity loss Large 6/M/88 L None Normal Yes Large signal intensity loss Large 7/F/87 L BG Small abnormality Yes Large signal intensity loss Large 8/M/78 R BG Small abnormality Yes Large signal intensity loss Large 9/M/64 R BG Small abnormality Yes Small signal intensity loss Small 10/F/32 L NEIS NA NA NA NA 11/M/73 L CF, IC Small abnormality Yes Large signal intensity loss Large 12/F/81 L CF, CP, BG Small abnormality Yes Large signal intensity loss Large 13/F/69 L CF, BG Small abnormality Yes Large signal intensity loss Large 14/F/73 R None Normal Yes Small signal intensity loss Large Note:—DWI indicates diffusion weighted image; MTT, mean transit time; CBV, cerebral blood volume; CF, cortex of the frontal lobe; IC, insular cortex; BG, basal ganglia; CP, cortex of the parietal lobe; NEIS, no early ischemic sign on cranial computed tomography; NA, not available.
Patient No./Sex/Age (y) Occluded Vessel Retrieval Devices Proximal Flow Blockade Additional Therapy Dose of Urokinase 1/M/82 ICA (C3) Soutenir MC PTCBA 0 2/M/81 ICA (C1) Soutenir MC PTCBA, LIF 30* 3/M/91 ICA (C7) Soutenir MC PTCBA 0 4/F/78 ICA (C6) No device MC No 0 5/M/88 ICA (C6) In-Time BGC PTCBA 0 6/M/88 ICA (C1) Soutenir BGC PTCBA 0 7/F/87 ICA (C3) In-Time BGC No 0 8/M/78 ICA (C7) Soutenir BGC No 0 9/M/64 ICA (C1) No device BGC No 0 10/F/32 ICA (C7) Soutenir BGC PTCBA 0 11/M/73 ICA (C7) No device BGC No 0 12/F/81 ICA (C7) Soutenir BGC PTCBA 0 13/F/69 ICA (C7) Soutenir BGC PTCBA 0 14/F/73 ICA (C3) No device BGC No 9 Note:—CRT indicates clot removal therapy; ICA, internal carotid artery; C1, carotid segment; C3, lacerum segment; C6, ophthalmic segment; C7, terminal segment; MC, manual compression; BGC, balloon guide catheter; PTCBA, percutaneous transluminal cerebral balloon angioplasty; LIF, localized intra-arterial fibrinolysis.
* ×104 units.
Patient No./Sex/Age (y) Angiographic Result Retrieved Clot Clot Captured with Snare Histologic Findings Procedure Time (min)* CT findings 24 h after Procedure 1/M/82 No recanalization Yes No NE 42 LLA 2/M/81 No recanalization No No NE 101 LLA 3/M/91 No recanalization Yes Yes NE 103 SLA (SCI), SHA 4/F/78 No recanalization No No NE 50 LLA 5/M/88 No recanalization Yes No NE 104 LLA 6/M/88 No recanalization No No NE 65 LLA 7/F/87 Complete recanalization Yes No NE 81 SLA (SCI) 8/M/78 Complete recanalization Yes Yes NE 45 SLA (SCI) 9/M/64 Complete recanalization Yes No PRC 43 SLA (SCI) 10/F/32 Partial recanalization Yes Yes PRC 97 SLA (SCI), SHA 11/M/73 No recanalization No No NE 87 LLA, SHA 12/F/81 Partial recanalization Yes No PRC 61 LLA 13/F/69 Partial recanalization No No NE 55 SLA (SCI), LLA 14/F/73 Complete recanalization Yes No FRC 40 SLA Note:—NE indicates no examination; PRC, platelet-rich clot; FRC, fibrin-rich clot; CT, computed tomography; LLA, large low-attenuation area; SLA, small low-attenuation area; SHA, small high-attenuation area; SCI, striatocapsular infarction.
* Time for obtaining an angiographic diagnosis and completing the procedure.
Methods of PFB Anatomic Feature* Angiographic Results Complete Recanalization Partial Recanalization No Recanalization Balloon guide catheter Ipsilateral A1 Large 4 3 1 Small/none 0 0 2 Manual compression Ipsilateral A1 Large 0 0 1 Small/none 0 0 3 Note:—PFB indicates proximal flow blockade; A1, horizontal segment of the anterior cerebral artery.
* Diagnosed by pre- or postprocedure magnetic resonance angiography or cerebral angiography.
Patient No./Sex/Age (y) Angiographic Result NIHSS Score Favorable Neurologic Outcome* mRS Score at 90 d after Procedure Procedure-related Complication On Admission At 7 d after Procedure 1/M/82 No recanalization 18 16 No 4 None 2/M/81 No recanalization 21 15 Yes 5 None 3/M/91 No recanalization 19 15 No 5 None 4/F/78 No recanalization 26 42 No 6 None 5/M/88 No recanalization 17 23 No 5 None 6/M/88 No recanalization 24 24 No 5 None 7/F/87 Complete recanalization 22 6 Yes 1 None 8/M/78 Complete recanalization 19 2 Yes 0 None 9/M/64 Complete recanalization 14 5 Yes 1 None 10/F/32 Partial reacanalization 24 12 Yes 2 None 11/M/73 No recanalization 18 14 No 4 None 12/F/81 Partial recanalization 21 42 No 6 Distal embolism† 13/F/69 Partial recanalization 17 9 Yes 2 None 14/F/73 Complete recanalization 21 4 Yes 1 None Note:—NIHSS indicates National Institutes of Health Stroke Scale; mRS, modified Rankin Scale.
* NIHSS scores at 7 days after procedure compared with baseline improved 5 or more points.
† Distal embolism to a small branch of the ipsilateral anterior cerebral artery.
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