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Erschienen in: Neuroradiology 11/2012

01.11.2012 | Interventional Neuroradiology

Manual aspiration thrombectomy through balloon-tipped guide catheter for rapid clot burden reduction in endovascular therapy for ICA L/T occlusion

verfasst von: Muneer Eesa, Mohammed A. Almekhlafi, Alim P. Mitha, John H. Wong, Mayank Goyal

Erschienen in: Neuroradiology | Ausgabe 11/2012

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Abstract

Introduction

Timely recanalization during endovascular procedures for acute ischemic stroke can be challenging in cases with large clot burden, such as those encountered in the terminal internal carotid T- or L-type occlusion.

Methods

A novel but simple technique to achieve fast reduction in clot burden in stroke patients with occlusion of the internal carotid artery termination is described where manual suction using a 60-ml syringe applied through an 8-F balloon guide catheter positioned in the cervical carotid vasculature with proximal flow arrest allows subsequent revascularization of the residual middle cerebral artery clot.

Results

The use of manual suction through a balloon-tipped guide catheter in internal carotid artery L- or T-type occlusion is illustrated. This resulted in a significant reduction of the clot burden and facilitated further interventions leading to full recanalization.

Conclusion

Manual suction using a 60-ml syringe through a ballon guide catheter is a useful and feasible technique that facilitates thrombectomy of large burden cerebral clots.
Literatur
1.
Zurück zum Zitat Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P, Watson T, Goyal M, Demchuk AM (2010) Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 41(10):2254–2258PubMedCrossRef Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P, Watson T, Goyal M, Demchuk AM (2010) Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 41(10):2254–2258PubMedCrossRef
2.
Zurück zum Zitat Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II Study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282(21):2003–2011PubMedCrossRef Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II Study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282(21):2003–2011PubMedCrossRef
3.
Zurück zum Zitat Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, Lutsep HL, Nesbit GM, Grobelny T, Rymer MM, Silverman IE, Higashida RT, Budzik RF, Marks MP (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36(7):1432–1438PubMedCrossRef Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, Lutsep HL, Nesbit GM, Grobelny T, Rymer MM, Silverman IE, Higashida RT, Budzik RF, Marks MP (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36(7):1432–1438PubMedCrossRef
4.
Zurück zum Zitat Bose A, Henkes H, Alfke K, Reith W, Mayer TE, Berlis A, Branca V, Sit SP (2008) The Penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol 29(7):1409–1413PubMedCrossRef Bose A, Henkes H, Alfke K, Reith W, Mayer TE, Berlis A, Branca V, Sit SP (2008) The Penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol 29(7):1409–1413PubMedCrossRef
5.
Zurück zum Zitat Machi P, Costalat V, Lobotesis K, Lima Maldonado I, Vendrell JF, Riquelme C, Bonafe A (2012) Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg 4(1):62–66PubMedCrossRef Machi P, Costalat V, Lobotesis K, Lima Maldonado I, Vendrell JF, Riquelme C, Bonafe A (2012) Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg 4(1):62–66PubMedCrossRef
6.
Zurück zum Zitat Frei D, Turk A, Heck D, Hui F, Joseph G, Jahan R, Carpenter J, Grobelny T, Goddard J, Leader B, Bose A, Sit S (2011) The SPEED trial: a study of the Penumbra early evacuation device. Paper presented at the International Stroke Conference Los Angeles, 01 Mar 2011 Frei D, Turk A, Heck D, Hui F, Joseph G, Jahan R, Carpenter J, Grobelny T, Goddard J, Leader B, Bose A, Sit S (2011) The SPEED trial: a study of the Penumbra early evacuation device. Paper presented at the International Stroke Conference Los Angeles, 01 Mar 2011
7.
Zurück zum Zitat Hesselmann V, Niederstadt T, Dziewas R, Ritter M, Kemmling A, Maintz D, Koehler M, Seifarth H, Jacobs AH, Ringelstein EB, Heindel W (2012) Reperfusion by combined thrombolysis and mechanical thrombectomy in acute stroke: effect of collateralization, mismatch, and time to and grade of recanalization on clinical and tissue outcome. AJNR Am J Neuroradiol 33:336–342PubMedCrossRef Hesselmann V, Niederstadt T, Dziewas R, Ritter M, Kemmling A, Maintz D, Koehler M, Seifarth H, Jacobs AH, Ringelstein EB, Heindel W (2012) Reperfusion by combined thrombolysis and mechanical thrombectomy in acute stroke: effect of collateralization, mismatch, and time to and grade of recanalization on clinical and tissue outcome. AJNR Am J Neuroradiol 33:336–342PubMedCrossRef
8.
Zurück zum Zitat Goyal M, Menon BK, Coutts SB, Hill MD, Demchuk AM (2011) Effect of baseline CT scan appearance and time to recanalization on clinical outcomes in endovascular thrombectomy of acute ischemic strokes. Stroke 42(1):93–97PubMedCrossRef Goyal M, Menon BK, Coutts SB, Hill MD, Demchuk AM (2011) Effect of baseline CT scan appearance and time to recanalization on clinical outcomes in endovascular thrombectomy of acute ischemic strokes. Stroke 42(1):93–97PubMedCrossRef
9.
Zurück zum Zitat Gralla J, Burkhardt M, Schroth G, El-Koussy M, Reinert M, Nedeltchev K, Slotboom J, Brekenfeld C (2008) Occlusion length is a crucial determinant of efficiency and complication rate in thrombectomy for acute ischemic stroke. AJNR Am J Neuroradiol 29(2):247–252PubMedCrossRef Gralla J, Burkhardt M, Schroth G, El-Koussy M, Reinert M, Nedeltchev K, Slotboom J, Brekenfeld C (2008) Occlusion length is a crucial determinant of efficiency and complication rate in thrombectomy for acute ischemic stroke. AJNR Am J Neuroradiol 29(2):247–252PubMedCrossRef
10.
Zurück zum Zitat King S, Khatri P, Carrozella J, Spilker J, Broderick J, Hill M, Tomsick T (2007) Anterior cerebral artery emboli in combined intravenous and intra-arterial rtPA treatment of acute ischemic stroke in the IMS I and II trials. AJNR Am J Neuroradiol 28(10):1890–1894PubMedCrossRef King S, Khatri P, Carrozella J, Spilker J, Broderick J, Hill M, Tomsick T (2007) Anterior cerebral artery emboli in combined intravenous and intra-arterial rtPA treatment of acute ischemic stroke in the IMS I and II trials. AJNR Am J Neuroradiol 28(10):1890–1894PubMedCrossRef
11.
Zurück zum Zitat Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, Brott T, Frankel M, Grotta JC, Haley EC Jr, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363(9411):768–774PubMedCrossRef Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, Brott T, Frankel M, Grotta JC, Haley EC Jr, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363(9411):768–774PubMedCrossRef
12.
Zurück zum Zitat Wester P, Radberg J, Lundgren B, Peltonen M (1999) Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective, multicenter study. Seek-Medical-Attention-in-Time Study Group. Stroke 30(1):40–48PubMedCrossRef Wester P, Radberg J, Lundgren B, Peltonen M (1999) Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective, multicenter study. Seek-Medical-Attention-in-Time Study Group. Stroke 30(1):40–48PubMedCrossRef
13.
Zurück zum Zitat Tan IY, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K, Martin M, Symons SP, Fox AJ, Aviv RI (2009) CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 30(3):525–531PubMedCrossRef Tan IY, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K, Martin M, Symons SP, Fox AJ, Aviv RI (2009) CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 30(3):525–531PubMedCrossRef
14.
Zurück zum Zitat Kulcsar Z, Bonvin C, Pereira VM, Altrichter S, Yilmaz H, Lovblad KO, Sztajzel R, Rufenacht DA (2010) Penumbra system: a novel mechanical thrombectomy device for large-vessel occlusions in acute stroke. AJNR Am J Neuroradiol 31(4):628–633PubMedCrossRef Kulcsar Z, Bonvin C, Pereira VM, Altrichter S, Yilmaz H, Lovblad KO, Sztajzel R, Rufenacht DA (2010) Penumbra system: a novel mechanical thrombectomy device for large-vessel occlusions in acute stroke. AJNR Am J Neuroradiol 31(4):628–633PubMedCrossRef
15.
Zurück zum Zitat Brekenfeld C, Schroth G, Mordasini P, Fischer U, Mono ML, Weck A, Arnold M, El-Koussy M, Gralla J (2011) Impact of retrievable stents on acute ischemic stroke treatment. AJNR Am J Neuroradiol 32(7):1269–1273PubMedCrossRef Brekenfeld C, Schroth G, Mordasini P, Fischer U, Mono ML, Weck A, Arnold M, El-Koussy M, Gralla J (2011) Impact of retrievable stents on acute ischemic stroke treatment. AJNR Am J Neuroradiol 32(7):1269–1273PubMedCrossRef
16.
Zurück zum Zitat Lutsep HL, Clark WM, Nesbit GM, Kuether TA, Barnwell SL (2002) Intraarterial suction thrombectomy in acute stroke. AJNR Am J Neuroradiol 23(5):783–786PubMed Lutsep HL, Clark WM, Nesbit GM, Kuether TA, Barnwell SL (2002) Intraarterial suction thrombectomy in acute stroke. AJNR Am J Neuroradiol 23(5):783–786PubMed
17.
Zurück zum Zitat Xu GF, Suh DC, Choi CG, Kim JK, Kim W, Kim SJ, Kim JS (2005) Aspiration thrombectomy of acute complete carotid bulb occlusion. J Vasc Interv Radiol 16(4):539–542PubMedCrossRef Xu GF, Suh DC, Choi CG, Kim JK, Kim W, Kim SJ, Kim JS (2005) Aspiration thrombectomy of acute complete carotid bulb occlusion. J Vasc Interv Radiol 16(4):539–542PubMedCrossRef
18.
Zurück zum Zitat Imai K, Mori T, Izumoto H, Takabatake N, Kunieda T, Shimizu H, Watanabe M (2006) Clot removal therapy by aspiration and extraction for acute embolic carotid occlusion. AJNR Am J Neuroradiol 27(7):1521–1527PubMed Imai K, Mori T, Izumoto H, Takabatake N, Kunieda T, Shimizu H, Watanabe M (2006) Clot removal therapy by aspiration and extraction for acute embolic carotid occlusion. AJNR Am J Neuroradiol 27(7):1521–1527PubMed
19.
Zurück zum Zitat Fesl G, Wiesmann M, Patzig M, Holtmannspoetter M, Pfefferkorn T, Dichgans M, Brueckmann H (2006) Endovascular mechanical recanalisation of acute carotid-T occlusions: a single-center retrospective analysis. Cardiovasc Intervent Radiol 34(2):280–286CrossRef Fesl G, Wiesmann M, Patzig M, Holtmannspoetter M, Pfefferkorn T, Dichgans M, Brueckmann H (2006) Endovascular mechanical recanalisation of acute carotid-T occlusions: a single-center retrospective analysis. Cardiovasc Intervent Radiol 34(2):280–286CrossRef
Metadaten
Titel
Manual aspiration thrombectomy through balloon-tipped guide catheter for rapid clot burden reduction in endovascular therapy for ICA L/T occlusion
verfasst von
Muneer Eesa
Mohammed A. Almekhlafi
Alim P. Mitha
John H. Wong
Mayank Goyal
Publikationsdatum
01.11.2012
Verlag
Springer-Verlag
Erschienen in
Neuroradiology / Ausgabe 11/2012
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-012-1039-3

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