Manual aspiration thrombectomy with a Penumbra catheter for acute anterior cerebral artery occlusion

Purpose The purpose of this article is to assess the efficacy and safety of manual aspiration thrombectomy (MAT) using a Penumbra catheter in patients with anterior cerebral artery (ACA) occlusions. Materials and methods From January 2012 to March 2016, 16 patients underwent MAT with Penumbra catheters using a proximal and distal supporting technique to treat ACA occlusions. We evaluated immediate angiographic results and clinical outcomes by reviewing patient electrical medical records. Results Of these patients, 11 had a complete obstruction of the distal internal carotid artery (ICA) and five had ACA and middle cerebral artery (MCA) occlusions. All patients achieved successful recanalization of the distal ICA or MCA (Thrombolysis in Cerebral Infarction (TICI) grade ≥2b). Overall the recanalization rate for ACA occlusions (TICI grade≥2b) was 93.7% (15/16). The median procedure time was 45 minutes (range: 35-65 minutes). No patients were observed to have a procedure-related subarachnoid hemorrhage. Four patients (25.0%) died during hospitalization because of massive symptomatic hemorrhage, brain edema, or herniation. At discharge, the median NIHSS score for surviving patients was 6 (range: 1-17). Five patients had favorable clinical outcomes (modified Rankin scale ≤2). Conclusion MAT appears to be safe and successfully achieves recanalization in patients with ACA occlusions.