Lightning Bolt^TM 7 Case Study: Restoring Flow to an Occluded Renal Artery with Computer Assisted Vacuum Thrombectomy (CAVT^TM)

Penumbra’s computer assisted vacuum thrombectomy (CAVT) system, Lightning Bolt 7, introduced modulated aspiration, an advanced and powerful method for removing blood clots. The CAVT platform utilizes hypotube catheters and advanced microprocessor algorithms designed to enhance the speed, safety and simplicity of thrombectomy. Since the launch of Lightning Bolt 7 we are seeing more cases that demonstrate rapid interventions for arterial blood clots.

One recent example comes from Dr. Allan Hoffman, a vascular and interventional radiologist affiliated with Lowell General Hospital in Massachusetts, who presents a case study of Lightning Bolt 7’s ability to quickly remove thrombus with minimal blood loss, shortening the patient’s length of stay and reducing bleed risk.

Patient Presentation
A male in his 70s with atrial fibrillation (AFib) presented with acute left flank pain four hours prior to arrival in ER. CTA revealed embolus in the left renal artery. Creatinine 2.02 mg/dl, eGFR 35 ml/min.

Intervention
A decision was made to proceed with Penumbra’s Lightning Bolt 7, for its low-profile design, able to navigate tortuous anatomy. Access was obtained through a 7 Fr Cook^® sheath placed at the ostium of the left renal artery. An 0.014” wire was navigated distally through the thrombus, and the Lightning Bolt 7 aspiration system was advanced over the wire. Slowly moving the catheter in and out of the occlusion, from the proximal to distal region, Lightning Bolt 7 successfully cleared 90% of the thrombus on the first pass. The second pass cleared the remaining thrombus. The total device time was under 10 minutes, with minimal blood loss (estimated 50cc).

Conclusion
The procedure was completed in under an hour, with successful recanalization of the left renal artery. Angiography confirmed full thrombus removal and restoration of distal flow. Renal function recovered over the following 5 days (Cr 1.54, eGFR 48 on discharge) and he avoided dialysis. Clearing the occlusion with Lightning Bolt 7 enabled the patient to avoid lytics, likely shortening their length of stay and avoiding the bleed risk associated with tPA¹. As a busy IR service in a high-acuity hospital, we were pleased with the procedure’s speed and success, and the patient was deeply appreciative for the positive results. Lightning Bolt 7 displayed its efficient ability in tracking through organized renal artery embolus and showcased the potential for more positive outcomes in challenging clinical settings.

1 Lurie F, Vaidya V, Comerota AJ. Clinical outcomes and cost-effectiveness of initial treatment strategies for nonembolic acute limb ischemia in real-life clinical settings. J Vasc Surg. 2015 Jan;61(1):138–146. doi: 10.1016/j.jvs.2014.07.086. Epub 2014 Aug 22.