Zenith devices used in this case:

Patient Information

• Female, 61 years old
• Paroxysmal slurred speech with left limb weakness for 2 days
• Left extremities muscle strength: 3-, positive pathological signs on the left side
• The patient's condition worsened during hospitalization, with sluggish pupillary light reflex, left extremities muscle strength decreased to 2, and persistent positive pathological signs on the left side.

Preoperative Angiography

Head and Neck CTA: Occlusion of the right internal carotid artery (ICA). Patent anterior communicating artery (ACom), providing collateral blood supply to the right middle cerebral artery (MCA).

Surgical Strategy

• A Balloon Guide Catheter (BGC) can be used to block proximal blood flow, facilitating large-bore aspiration thrombectomy.
• If necessary, a combination of BGC, aspiration, and stent retriever thrombectomy may be employed to reduce the risk of thrombus fragmentation and embolization, increase the recanalization rate, and shorten the time to reperfusion

Devices used

• 8F BGC
• 6F-133cm Zenith Aspiration Catheter
• Synchro-14 200cm Microguide Wire
• Rebar-18 Microcatheter
• 4*30mm Zenith Stent Retriever

Procedure

Preoperative DSA: Occlusion of the right internal carotid artery (ICA).

Intraoperative DSA: Recanalization of the extracranial segment achieved with aspiration thrombectomy under BGC assistance; large thrombus burden observed.

Intraoperative DSA: True lumen confirmed after crossing the occluded segment under BGC protection.

Intraoperative DSA: A 4mm*30mm Zenith Stent Retriever was implanted under BGC protection.

Intraoperative DSA: Persistent occlusion at the ICA terminus; true lumen re-confirmed.

Intraoperative DSA: A 4mm*30mm Zenith Stent Retriever was implanted under BGC protection.

Intraoperative DSA: Complete thrombus removal achieved; full recanalization with TICI grade 3 flow.

Postoperative Angiography

• Conscious, alert, and in stable mental status; Speech is relatively clear
• Left extremities muscle strength: 3-; Positive pathological reflexes on the left side
• Continued warfarin anticoagulation therapy

Postoperative DSA: Patent right internal carotid artery with TICI grade 3 reperfusion.

Postoperative Day 1 Head CT Review：

Surgeon Information

Yifeng Liu and Changming Wen, Nanyang Central Hospital