title: Rescue forced-suction thrombectomy using the reperfusion catheter of the Penumbra System for thromboembolism during coil embolization of ruptured cerebral aneurysms.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, Daegu-Gyeongbuk Cardiocerebrovascular Center, Kyungpook National University, Daegu, Republic of Korea.
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Kang
authors.forename: Yong-Sun
authors.initials: YS
authors.lastname: Kim
authors.forename: Jaechan
authors.initials: J
authors.lastname: Park
authors.forename: Yang-Ha
authors.initials: YH
authors.lastname: Hwang
mesh_terms: D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013396:Suction / Q000295:instrumentation; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods; D013923:Thromboembolism / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*