Lightning Bolt^® Technology Restores Blood Flow in Rutherford 2b Limb Ischemia

Penumbra Inc.’s comprehensive product portfolio allows physicians to use its Computer Assisted Vacuum Thrombectomy (CAVT^TM) technology on an ever-widening patient population and on more complicated cases throughout the body.

Dr. Visharad Patel at Wellstar North Fulton Hospital in Roswell, GA used Lightning Bolt 7 to remove a large thrombus from the distal popliteal artery and then employed Lightning Bolt 6X with TraX^TM to extract additional emboli from below the knee. Both Lightning Bolt 7 and 6X employ the latest in clot removal and modulated aspiration, designed to more efficiently remove blood clots. Lightning Bolt 6X, the latest catheter for arterial clot removal, includes a trackable 6F catheter design and comes packed with the first Penumbra arterial-designed dilator, engineered to track quickly to the distal vasculature.

Case Report from Dr. Patel

Patient Presentation
A 61-year-old female patient was admitted to Wellstar North Fulton Medical Center with symptoms of a cold leg, indicating possible compromised circulation. Upon examination, her leg was noted to be cool to the touch, with diminished pulses and altered skin color. She also exhibited moderate pain, motor impairment, and minor swelling in her leg. The clinical presentation was concerning Rutherford 2b limb ischemia, prompting urgent intervention.

Intervention
After reviewing the patient’s condition, it was clear the best course of action was to pursue an endovascular approach because of the distal, multilevel thrombus. Contralateral access was gained using a 65 cm Terumo 7 French Destination sheath. Using Penumbra’s Lightning Bolt 7, intervention started in the distal popliteal artery. After one pass through the occluded area the large piece of thrombus was removed. An angiogram was then performed, revealing additional smaller emboli down the anterior tibial artery. However, we determined that Bolt 7 would be too large for the remaining thrombus below the knee. We decided to switch to the Lightning Bolt 6X catheter and proceeded with a second pass, successfully removing the smaller embolic fragments. The total time of procedure was 30 minutes while the time spent using both Lightning Bolt 7 and 6X with TraX was 3 minutes.

The staff and I felt the device worked efficiently and was easy to use, providing quick removal of thrombus without complications. The entire procedure was seamless and the hospital staff were impressed with the system’s performance.

Conclusion
This was our second experience with CAVT technology, and the staff was extremely satisfied with the simplicity and efficiency of the system. Lightning Bolt 7 successfully removed clot in the distal popliteal artery, while Lightning Bolt 6X with TraX catheter was highly effective in addressing smaller embolized fragments in the AT. The staff was impressed with its ability to navigate complex anatomy while delivering rapid results. The combination of versatility, speed, and overall patient outcome by using CAVT proved to be superior to traditional open surgery. These results further emphasize why our practice is switching to frontline endovascular thrombectomy with CAVT.