Abstract 198: Case Report: Thrombectomy using Zoom Reperfusion System In Pediatric Acute Ischemic Strokes
Authors: Singh Raman , Jen Shyian , Shakir Hakeem , Verma Uttam 
Published: March 2024

Introduction
Zoom reperfusion system (Imperative Care, CA) has proven to be promising for use in mechanical thrombectomies in adults but has not been described in pediatrics to our knowledge. We present two cases of a 14‐year‐old boy with acute right middle cerebral artery (MCA) syndrome and a 10‐year‐old boy with acute left MCA syndrome who underwent mechanical thrombectomy using Zoom Reperfusion System safely with TICI 2B and 3 recanalization respectively.

Methods
Case report and review of literature

Results
Case 1:
14‐year‐old previously healthy boy presented to our facility for acute right MCA syndrome secondary to right supraclinoid internal carotid artery (ICA) occlusion. After receiving alteplase, patient was taken for mechanical thrombectomy.
After femoral access was obtained, an 8‐French sheath was introduced into the right femoral artery through which a Zoom 88 catheter and 5‐French BERN catheter (Terumo) were coaxially advanced over a Terumo Glidewire into the right common carotid artery. Under roadmap guidance, the Zoom 88 catheter was parked at the lacerum ICA segment with BERN catheter and Glidewire then removed. Angiogram demonstrated complete occlusion of the ICA just past the origin of the ophthalmic artery. Via Zoom 88 catheter, a Zoom 71 catheter was then navigated to the face of clot over a velocity microcatheter (Penumbra) and synchro 2 wire system (Stryker) which was then removed. The vacuum manifold was then attached to Zoom 71 catheter and allowed to engage with the clot for 3 minutes prior to withdrawal into the Zoom 88 catheter. TICI 2B recanalization was achieved with sub‐occlusive thrombus within the proximal M1 segment. Retrieval of the sub‐occlusive thrombus in the M1 segment was performed with TREVO stentriever (Stryker). Procedure was complicated by vasospasm in the A1 and M2 segments which resolved with milrinone and verapamil infused through the Zoom 88 catheter.
Case 2: 10‐year‐old with left hypoplastic heart syndrome presented to our facility for acute left MCA syndrome due to left ICA terminus occlusion. Mechanical thrombectomy was performed after receiving alteplase.
Femoral artery access was obtained with a 8‐French sheath, through which Zoom 88 catheter and 5‐French select catheter (Penumbra) were advanced over Terumo Glidewire into the left common carotid artery. Under roadmap guidance, the Zoom 88 catheter was parked at the ophthalmic segment of ICA with select catheter and Glidewire then removed. Angiogram demonstrated complete occlusion at the ICA terminus. Zoom 71 catheter was introduced through Zoom 88 catheter and navigated to the face of clot at the ICA terminus over velocity microcatheter (Penumbra) and synchro wire system (Stryker) which was then removed. Zoom 71 was then attached to a vacuum manifold to engage with the clot for 90 seconds. TICI 2A recanalization after first pass was achieved with flow restoration in anterior cerebral artery but none in the MCA.TICI 3 recanalization was achieved after second pass.

Conclusion
The use of Zoom reperfusion system potentially proves to be safe for use in the pediatric age group with good recanalization results and no intraoperative or postoperative complications.