case_images: PMC11382243_01
case_images: Angiography demonstrated occlusion of the proximal ulnar and radial arteries (blue arrows in a). Aspirations thrombectomy by a 6F Eliminate Catheter (Terumo) failed to restore flow (b). Thus, the radial and ulnar arteries remained occluded and only small collaterals were detectable to the arm provided by an interosseous artery (blue arrow in c). A 3F Penumbra catheter was inserted through the sheath and was advanced to the distality of both the radial and the ulnar arteries (d). Hereby, successful restoration of blood flow was achieved in both vessels, with reconstruction of the palmar arch (e).
case_images: 10.1177_17539447241271989-fig1.jpg
case_images: PMC11382243_01_10.1177_17539447241271989-fig1.jpg
case_images: fig1-17539447241271989
case_images: Angiography confirmed thrombotic occlusion of the proximal ulnar and radial arteries (Figure 1(a)). However, despite some clot removal, flow restorage was not possible despite multiple aspiration attempts (Figure 1(b) and (c)). Hereby, a 3F Penumbra catheter was inserted through the sheath and was advanced to the distality of both the radial and the ulnar arteries (Figure 1(d)). After two passages in the radial artery and a single passage in the ulnar artery, successful restoration of blood flow was achieved in both vessels, with reconstruction of the palmar arch (Figure 1(e)).
case_images: PMC11382243_02
case_images: Catheter-directed thrombolysis failed to restore flow in both internal iliac arteries (a). Therefore, mechanical thrombectomy was performed using a Penumbra Lightning 7 catheter (b, c), which restored blood flow in both arteries (d). Follow-up magnetic resonance angiography after 6 months showed sustained patency of both internal iliac arteries (e). The asterisks point to the off-resonance artifacts causing signal void at the area of the stent prostheses in the iliac arteries.
case_images: 10.1177_17539447241271989-fig2.jpg
case_images: PMC11382243_02_10.1177_17539447241271989-fig2.jpg
case_images: fig2-17539447241271989
case_images: CDT was subsequently performed over 24 h, but occlusion of the internal iliac arteries remained, as verified by a second-look angiography, which was conducted at the following day (Figure 2(a)). After surgical cut-down in the distal axillar artery and insertion of a 7F sheath, which was advance to the distal abdominal aorta, mechanical thrombectomy was performed bilaterally using a Penumbra Lightning 7 catheter (Figure 2(b) and (c)), followed by drug-coated balloon angioplasty of both internal iliac arteries. By this combined approach, complete patency was achieved in both internal iliac arteries (Figure 2(d)). Follow-up MRA after 6 months exhibited patency of both internal iliac arteries (Figure 2(e)).