Author: Dr. Giacomo Isernia
Institution: Department of Vascular and Endovascular Surgery, S. Maria della Misericordia Hospital, Perugia, Italy
Abstract
This paper presents the mechanical thrombectomy technique for below-knee (BTK) clot removal, specifically the application of the innovative Lightning mechanical thrombectomy system in patients with acute limb ischemia (ALI). The key benefits of this technology include shorter procedural times, reduced blood loss, and improved clot removal efficiency. Multiple clinical cases are discussed, showcasing the practical application and outcomes of this technology.
Introduction
Acute limb ischemia (ALI) is a limb-threatening emergency, often caused by arterial thrombosis or embolism. BTK arteries pose a particular challenge due to the difficulty in clot removal. Traditional surgical or thrombolysis methods have limitations in some cases, but mechanical thrombectomy provides a novel solution for ALI treatment. This paper discusses the Lightning system, developed by Penumbra, and analyzes its clinical use in detail.
Lightning System Overview
•Key Features: The Lightning system utilizes dual pressure sensors to monitor real-time blood flow and uses a microprocessor-controlled thrombectomy algorithm to automate valve control. This ensures precise clot removal with minimal vascular injury. The system features a 7 F (2.3 mm) low-profile catheter, which can access narrow arteries.
Clinical Case Analysis
•Case 1: 65-year-old male
•History: Hypertension, dyslipidemia
•Presentation: Patent superficial femoral artery (SFA) and popliteal artery, but no flow in BTK vessels. The Lightning system successfully removed the BTK clot, restoring blood flow. The patient was discharged four days post-procedure.
•Case 2: 83-year-old male
•History: Diabetes, hypertension, dyslipidemia, previous abdominal aortic aneurysm repair. BTK thrombosis was treated using the Lightning system and selective angioplasty, restoring flow and avoiding further open surgery.
Conclusion
1.The Lightning mechanical thrombectomy system offers an effective solution for BTK clot removal, showing excellent performance in patients with acute limb ischemia.
2.The system reduces procedural times and blood loss while improving clot removal success rates, positioning it as a complementary treatment to current standards.
3.As technology evolves, future thrombectomy devices will continue to optimize outcomes, benefiting more complex cases with this innovative approach.
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