Advantages to Indigo mechanical thrombectomy for ALI: device and technique.

Catheter-directed thrombolysis (CDT) has been used as the first therapeutic option for acute limb ischemia (ALI) due to its less invasive nature; however, recent systematic review showed higher incidence of major complications related to lytic infusion, including hemorrhagic stroke. In this setting, aspiration thrombectomy with Indigo has the greatest advantage of not increasing systemic risk of bleeding. The Indigo™ system from Penumbra® (Alameda, CA, USA) promotes active thrombectomy using a vacuum pump that generates substantial suction, enabling aspiration of clots of varying sizes and lengths. The device has three components: aspiration catheter, separator and pump. There are 2 aspiration catheter sizes: CAT 3 and CAT 5. The separators are intended to mobilize the clot and clean the catheter lumen, and therefore restoring flow for continuous aspiration. The pump is small-sized equipment capable of applying near pure vacuum aspiration pressure of -29 mmHg. Aspiration thrombectomy with Indigo has two key advantages: it does not require the use of lytics, and it provides immediate flow reestablishment. Its use when thrombolysis is contraindicated or has failed is already well established and, in the future, it may likely become the first line endovascular option in patients with acute limb ischemia.