Abstract
Objective: The Penumbra System (PS) is an endovascular thrombectomy device used to achieve mechanical revascularization. However, revascularization is not always possible even with the application of this device. Herein we report a case of revascularization using the "pull-back method", by which the thrombus is aspirated while the PS is withdrawn from the occluded area to a more distal location.
Case: A 74-year-old male presented with sudden-onset left hemiparesis. Magnetic resonance imaging revealed early ischemic changes in the right corona radiata, and a carotid angiogram revealed complete occlusion of the right middle cerebral artery. After intravenous recombinant tissue plasminogen activator (rt-PA) therapy, his National Institute of Health Stroke Scale (NIHSS) score deteriorated, and endovascular therapy was performed. An attempt at thrombus recovery from a proximal area using the PS failed to achieve revascularization. Therefore, the PS was placed in a location distal to the thrombus, and "the pull-back method" was employed during aspiration, which aided in achieving rapid revascularization.
Conclusion: The "pull-back method" can be effective in cases where thrombus recovery from a proximal area is difficult.
