Rescue forced-suction thrombectomy using the reperfusion catheter of the Penumbra System for thromboembolism during coil embolization of ruptured cerebral aneurysms

Neurosurgery. 2012 Mar;70(1 Suppl Operative):89-93; discussion 93-4. doi: 10.1097/NEU.0b013e31822fefc4.


Background: No definite conclusive management has been established in the treatment of thromboembolism during coil embolization of cerebral aneurysms. To date, intravenous heparin, intra-arterial fibrinolytic agent, and intravenous or intra-arterial glycoprotein IIb-IIIa inhibitors have been the mainstay of treatment. However, in practice, 2 major concerns may arise; first, recanalization is not always possible despite every effort of management; second, rehemorrhagic risk is increased if the event occurred during coiling of ruptured cerebral aneurysms.

Objective: We introduce a new endovascular mechanical thrombectomy technique to overcome the aforementioned concerns.

Methods: In 4 refractory cases involving conventional pharmaceutical treatment of thromboembolism during coiling, we practiced rescue suction thrombectomy using the reperfusion catheter of the Penumbra System.

Results: All 4 of the patients to whom this technique was applied were successfully recanalized; 2 were Thrombolysis In Cerebral Infarction scale of 2b and the other 2 were a scale of 3. Recanalization was confirmed at the follow-up angiography at least 12 hours after the procedure. No complication associated with this technique occurred.

Conclusion: Forced-suction thrombectomy is a simple modification of the Penumbra System. Based on our preliminary data, this technique can play a role as an adjuvant management or as a last resort combined with injection of glycoprotein IIb-IIIa inhibitors in thromboembolic events that occur in coil embolization of a ruptured cerebral aneurysm.

Publication types

  • Case Reports

MeSH terms

  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / pathology
  • Aneurysm, Ruptured / therapy*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Blood Vessel Prosthesis Implantation / methods
  • Catheterization / instrumentation*
  • Catheterization / methods
  • Embolization, Therapeutic / adverse effects*
  • Embolization, Therapeutic / instrumentation*
  • Embolization, Therapeutic / methods
  • Female
  • Humans
  • Intraoperative Complications / etiology
  • Intraoperative Complications / physiopathology
  • Intraoperative Complications / therapy*
  • Male
  • Middle Aged
  • Radiography
  • Suction / instrumentation
  • Thrombectomy / instrumentation*
  • Thrombectomy / methods
  • Thromboembolism / etiology
  • Thromboembolism / physiopathology
  • Thromboembolism / therapy*