Zenith devices used in this case:

Patient Information

• Male, 62 years old
• Dizziness for 1 day, followed by 3.5 hours of left limb weakness, slurred speech, and slowed response.
• Muscle strength: 4/5 on the left side, 5/5 on the right side; bilateral pathological reflexes negative.
• NIHSS scores：8

Preoperative Angiography

Head CT:

Head DWI+ADC:

Head MRA:

Preliminary Diagnosis:

• Acute cerebral infarction
• Right internal carotid artery occlusion

Procedure Plan: Thrombectomy and stent angioplasty of the right ICA

Devices

• Loach guidewire
• Pigtail angiographic catheter
• 5F SIM II diagnostic catheter
• 6F Zenith Delivery Catheter
• 5F Zenith Distal Access Catheter
• 021inch Zenith Microcatheter
• 014inch Microguide Wire
• 2mm*10mm Balloon
• 027inch Microcatheter
• 4mm*20mm Neuroform EZ Stent

Procedure

Type III aortic arch:

Angiography of the right common carotid artery

A 2.6-meter Loach guidewire was advanced into the right occipital artery and fixed in position. The 6F Zenith Delivery Catheter was advanced over the guidewire to the distal right CCA. The 5F Zenith Distal Access Catheter was inserted coaxially. After retracting the Loach wire, super selection of the right ICA was achieved. Both the distal access catheter and delivery catheter were advanced coaxially to the C2 segment without resistance.

The distal access catheter was carefully advanced to the C4 segment; backflow ceased, and large amounts of thrombus were aspirated under negative pressure. Manual contrast injection revealed severe stenosis at the C4 segment. Micro guidewire and microcatheter were advanced.

A balloon was introduced and dilation was performed. Post-dilation angiography showed improvement in stenosis, though dissection at C4 could not be ruled out.

A Neuroform EZ stent was implanted. Anteroposterior and lateral angiography confirmed good stent deployment, wall apposition, and restoration of distal flow.

Postoperative Angiography

Postoperative Comments

Due to the patient's Type III arch and challenging access via the femoral artery, a transradial approach was chosen. However, the acute angle between the right CCA and subclavian artery posed a challenge for establishing a stable access route. The 6F Zenith Delivery Catheter successfully navigated the tortuous anatomy and reached the distal C2 segment without kinking, even in a narrow angulation. This stable and reliable access played a crucial role in the success of the transradial neurointervention, offering strong support and enabling the safe completion of the procedure.

Surgeon Information

Zhiyi Liu, Honghao Li and Hongru Deng, The First People's Hospital of Shenyang