Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020;14(5):169-176.
doi: 10.5797/jnet.oa.2020-0003. Epub 2020 Mar 13.

Analysis of the Anatomical Factors Affecting Ability to Navigate Penumbra Catheter through Internal Carotid Siphon

Emi Kuriyama  1 , Yoshikazu Matsuda  1 , Takumi Kawaguchi  1 , Rie Yako  1 , Naoyuki Nakao  1
Affiliations

Analysis of the Anatomical Factors Affecting Ability to Navigate Penumbra Catheter through Internal Carotid Siphon

Emi Kuriyama et al. J Neuroendovasc Ther. 2020.

Abstract

Objective: The efficacy and safety of aspiration thrombectomy using Penumbra catheter with acute large vessel occlusion in the anterior circulation have been reported in previous studies. In some cases, the carotid siphon (CS) is elongated, and with this anatomy, especially where there is bifurcation of the ophthalmic artery (OA), navigation of Penumbra catheters into distal internal carotid artery (ICA) is interrupted, which is known as the 'ledge effect'. We investigate the anatomical characteristics of CS that cause interruption of navigation of the Penumbra catheter.

Methods: Between January 2015 and March 2018, mechanical thrombectomy using Penumbra 60 was performed on 51 patients with middle cerebral artery (MCA) or intracranial ICA occlusion. Patients were divided into two groups: The 'ledge-effect' group those in whom the Penumbra catheter was unable to be navigated into the distal ICA through the CS, and 'no ledge-effect' group those in whom this was possible. The anatomical characteristics of CS, the diameter of ICA, diameter of OA, OA/ICA ratio and radius of the CS were evaluated using angiographical imaging.

Results: The 'ledge-effect' group numbered eight cases (17%). Only the value of the CS radius was significantly smaller in the ledge-effect group (p = 0.0019), other parameters were not significantly different between the groups. The cutoff radius value was 3.62 mm.

Conclusion: The most notable anatomical factor affecting possibility of navigation of the Penumbra catheter through the CS was the CS radius. This could be useful information when devices used in mechanical thrombectomy are selected.

Keywords: Penumbra catheter; carotid siphon; mechanical thrombectomy.

PubMed Disclaimer

Conflict of interest statement

There is no conflict of interest for the first author and coauthors.

Figures

Fig. 1
Fig. 1. Lateral angiography shows representative CS. Radius of the CS was defined as the diameter (white arrow) of the circle (white circle) passing the centerline of the CS through three points: (A) midpoint of the diameter in ICA at bifurcation of OA, (B) the vertex of ICA genu, and (C) the proximal C3 (white dots). CS: carotid siphon; ICA: internal carotid artery; OA: ophthalmic artery
Fig. 2
Fig. 2. Flowchart for exclusion and inclusion of the patients underwent thrombectomy in our study
Fig. 3
Fig. 3. (A) Representative case, a 72-year-old female, with small radius of CS (3.54 mm) and ledge-effect group is shown. Small radius indicates severe bending of the CS. Diameter of ICA is 5.46 mm, diameter of OA is 0.94 mm, and OA/ICA ratio is 0.17. (B) Diagnostic angiography shows the occlusion of ICA top. (C) Stent retriever Trevo 4 × 20 mm was deployed across the thrombus. Penumbra catheter was navigated just proximal of Trevo. Trenumbra was conducted. (D) Two passes of the same procedure showed full recanalization on final angiography. CS: carotid siphon; ICA: internal carotid artery; OA: ophthalmic artery
See this image and copyright information in PMC

References

    1. Turk AS, Spiotta A, Frei D, et al. : Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg 2018; 10: i20–i25. - PubMed
    1. Delgado Almandoz JE, Kayan Y, Young ML, et al. : Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointerv Surg 2016; 8: 1123–1128. - PubMed
    1. Humphries W, Hoit D, Doss VT, et al. : Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg 2015; 7: 90–94. - PubMed
    1. McTaggart RA, Tung EL, Yaghi S, et al. : Continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE): a technique which improves outcomes. J Neurointerv Surg 2017; 9: 1154–1159. - PubMed
    1. Maus V, Behme D, Kabbasch C, et al. : Maximizing first-pass complete reperfusion with SAVE. Clin Neuroradiol 2018; 28: 327–338. - PubMed