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Clot retrieval

Jongseong Kim, Jung E Park, Matthias Nahrendorf, Dong-Eog Kim
There is an emergent need for imaging methods to better triage patients with acute stroke for tissue-plasminogen activator (tPA)-mediated thrombolysis or endovascular clot retrieval by directly visualizing the size and distribution of cerebral thromboemboli. Currently, magnetic resonance (MR) or computed tomography (CT) angiography visualizes the obstruction of blood flow within the vessel lumen rather than the thrombus itself. The present visualization method, which relies on observation of the dense artery sign (the appearance of cerebral thrombi on a non-enhanced CT), suffers from low sensitivity...
September 2016: Journal of Stroke
Y Pan, J Zhao, J Mei, M Shao, J Zhang, H Wu
OBJECTIVE: The incidence of thrombus was investigated within retrievable filters placed in trauma patients with confirmed DVT at the time of retrieval and the optimal treatment for this clinical scenario was assessed. A technique called "filter retrieval with manual negative pressure aspiration thrombectomy" for management of filter thrombus was introduced and assessed. METHODS: The retrievable filters referred for retrieval between January 2008 and December 2015 were retrospectively reviewed to determine the incidence of filter thrombus on a pre-retrieval cavogram...
September 27, 2016: European Journal of Vascular and Endovascular Surgery
Diogo C Haussen, Mehdi Bouslama, Jonathan A Grossberg, Raul G Nogueira
The use of balloon guide catheters in acute ischemic stroke intervention has been associated with improved reperfusion rates and clinical outcomes. This technique acts by promoting flow arrest and subsequent reversal to capture the thrombus debris that may be generated during the clot retrieval process. However, to the best of our knowledge, the use of BGC to remotely aspirate and remove intracranial thrombus has not been previously described. We report a three case series of patients with acute ischemic stroke from supraclinoidal internal carotid artery occlusions treated with remote aspiration thrombectomy through a BGC placed at the cervical internal carotid artery, leading to complete reperfusion without the need for intracranial catheterization...
September 28, 2016: Journal of Neurointerventional Surgery
Marc Maegele, Oliver Grottke, Herbert Schöchl, Oliver A Sakowitz, Michael Spannagl, Jürgen Koscielny
BACKGROUND: Direct (non-vitamin-K-dependent) oral anticoagulants (DOAC) are given as an alternative to vitamin K antagonists (VKA) to prevent stroke and embolic disease in patients with atrial fibrillation that is not due to pathology of the heart valves. Fatal hemorrhage is rarer when DOACs are given (nonvalvular atrial fibrillation: odds ratio [OR] 0.68; 95% confidence interval [95% CI: 0.48; 0.96], and venous thromboembolism: OR 0.54; [0.22; 1.32]). 48% of emergency trauma patients need an emergency operation or early surgery...
September 5, 2016: Deutsches Ärzteblatt International
Hoon Kim, Seong Rim Kim, Ik Seong Park, Young Woo Kim
Cerebral venous sinus thrombosisis an uncommon entity and its clinical presentations are highly variable. We present the case of superior sagittal sinus thrombosis. Although it was medical refractory, successfully treated with mechanical thrombectomy using the Solitaire FR device. A 27-year-old man who presented with venous infarction accompanied by petechial hemorrhage secondary to the superior sagittal sinus (SSS) thrombosis. Due to rapid deterioration despite of anticoagulation therapy, the patient was taken for endovascular treatment...
September 2016: Journal of Korean Neurosurgical Society
Fatih Seker, Johannes Pfaff, Marcel Wolf, Silvia Schönenberger, Simon Nagel, Christian Herweh, Mirko Pham, Martin Bendszus, Markus A Möhlenbruch
PURPOSE: The impact of thrombus length on recanalization in IV thrombolysis for acute intracranial artery occlusion has been well studied. Here we analyzed the influence of thrombus length on the number of thrombectomy maneuvers needed for recanalization, intraprocedural complications, recanalization success, and clinical outcome after mechanical thrombectomy. METHODS: We retrospectively analyzed angiographic and clinical data from 72 consecutive patients with acute occlusion of the M1 segment of the middle cerebral artery who were treated with mechanical thrombectomy using stent retrievers...
September 15, 2016: Journal of Neurointerventional Surgery
Maxim Mokin, Elad I Levy, Adnan H Siddiqui, Mayank Goyal, Raul G Nogueira, Dileep R Yavagal, Vitor M Pereira, Jeffrey L Saver
BACKGROUND: The clot burden score (CBS) was developed as a tool to evaluate the extent of intracranial thrombus burden in patients with anterior circulation acute ischemic stroke. CBS is based on the presence or absence of contrast opacification on CT angiography (CTA). Its value in predicting radiographic and clinical outcomes in patients given endovascular stroke therapy remains unknown. OBJECTIVE: To evaluate the relationship between CBS and outcomes after stent retriever thrombectomy in the interventional arm of the SWIFT PRIME trial...
September 15, 2016: Journal of Neurointerventional Surgery
Peter S Y Yu, Herman H M Chan, Rainbow W H Lau, Freddie G Capili, Malcolm J Underwood, Innes Y P Wan
Video-assisted thoracic surgery (VATS) is widely adopted in acute management of patient with thoracic trauma, but its use in penetrating thoracic injuries with retained foreign bodies were rarely reported. We described three of such cases using VATS as the first line approach. Identification of injuries, control of bleeders, clot evacuation, resection of damaged lung parenchyma and safe retrieval of foreign bodies were all performed via complete VATS within short operative time. Patient were uneventfully discharged during early post-operative period...
August 2016: Journal of Thoracic Disease
Kojiro Ishikawa, Tomotaka Ohshima, Masahiro Nishihori, Tasuku Imai, Shunsaku Goto, Taiki Yamamoto, Toshihisa Nishizawa, Shinji Shimato, Kyozo Kato
The optional endovascular approach for acute ischemic stroke is unclear. The Trevo stent retriever can be used as first-line treatment for fast mechanical recanalization. The authors developed a treatment protocol for acute ischemic stroke based on the assessment of clot quality during clot removal with the Trevo. This prospective single-center study included all patients admitted for acute ischemic stroke between July 2014 and February 2015, who underwent emergency endovascular treatment. According to the protocol, the Trevo was used for first-line treatment...
August 2016: Nagoya Journal of Medical Science
Tomoyuki Tsumoto, Yuichiro Tsurusaki, So Tokunaga
BACKGROUND: The mechanism by which a stent retriever removes intraluminal thrombus from an occluded vessel in humans has not previously been studied. This study performed contrast-enhanced high-resolution cone beam CT (CE-HRCBCT) during deployment of the stent retriever to observe the interaction between the strut and intraluminal thrombus intraoperatively. We also discuss the mechanism by which the thrombus is retrieved. METHODS: In 11 patients, mechanical thrombectomy was performed with a Solitaire stent retriever...
August 19, 2016: Journal of Neurointerventional Surgery
Catherine Hatzantonis, Marcin Czyz, Renata Pyzik, Bronek M Boszczyk
BACKGROUND: Vertebroplasty carries multiple complications due to the leakage of polymethylmethacrylate (PMMA) into the venous system through the iliolumbar or epidural veins. The rate of venous cement complications may vary from 1 to 10 %, with cement extravasation into the venous system in 24 % of patients. Emboli may further migrate into the right heart chambers and pulmonary arteries. Patients may vary in presentation from asymptomatic or symptoms such as syncope to life-threatening complications...
August 17, 2016: European Spine Journal
Batuhan Kara, Hatem Hakan Selcuk, Omer Yıldız, Damla Cetinkaya
No abstract text is available yet for this article.
August 10, 2016: Clinical Neuroradiology
Bruce C V Campbell
Acute ischemic stroke is responsible for around 80% of all strokes and is a leading cause of disability and death globally. There are two potential treatment strategies: restoring blood flow (reperfusion) and preventing cellular injury (neuroprotection). As yet, all the successful trials have involved reperfusion with numerous failures of neuroprotectants. There are two proven reperfusion strategies. Intravenous thrombolysis with alteplase was first demonstrated to reduce disability with publication of the National Institute of Neurological Disorders and Stroke tissue plasminogen activator trial in 1995...
July 29, 2016: Seminars in Thrombosis and Hemostasis
Dhuleep S Wijayatilake, Gamunu Ratnayake, Dassen Ragavan
PURPOSE OF REVIEW: Endovascular management of acute thrombotic strokes is a new management technique. Anaesthesia will play a key role in the management of these patients. To date there is no established method of managing these patients from an anaesthetic perspective. RECENT FINDINGS: In 2015, five landmark studies popularized intra-arterial clot retrieval for ischaemic strokes. Since then there have been a number of small studies investigating the best anaesthetic technique, taking into account patient, technical, and clinical factors...
October 2016: Current Opinion in Anaesthesiology
Hilde Gundersen, Barry Moynihan
Our objective is to present the case of an uncommon but probably under-recognized cause of stroke: Non-bacterial thrombotic endocarditis (NBTE). A 59-year-old man presented to our hospital with multiple bihemispheric infarcts despite taking rivaroxaban for pulmonary emboli diagnosed 2 weeks earlier. The patient's symptoms progressed quickly and he died within a week of his initial presentation despite attempts at neuroradiologically guided clot retrieval and early recognition and treatment of disseminated intravascular coagulation...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Yong-Won Kim, Dong-Hun Kang, Yang-Ha Hwang, Jaechan Park, Yong-Sun Kim
OBJECTIVE: Mechanical thrombectomy (MT) for acute intracranial internal carotid artery (ICA) occlusion is often complicated by difficult revascularization and non-involved territory embolization possibly related with larger clot-burden. This study aims to evaluate the efficacy of proximal aspiration thrombectomy (PAT) using a balloon-tipped guide catheter for clot-burden reduction in such cases with period-to-period analysis (period 1 : standard MT without PAT; period 2 : PAT first, then standard MT for the remaining occlusion)...
July 2016: Journal of Korean Neurosurgical Society
Scott A Shapiro, Ian Kainoa White
INTRODUCTION: Patients with symptomatic thrombophilia are treated with therapeutic anticoagulation. These patients can require neurosurgery. The patient must have their anticoagulation reversed before, during, and after surgery. After surgery they must be anticoagulated again. This entails a risk of embolic and hemorrhagic complications. Eighty-seven of these patients underwent neurosurgery between 2003 and 2015. Forty-two had a retrievable inferior vena cava filter before surgery and 45 had no filter placed...
August 2016: Neurosurgery
Vikram Huded, Vivek Nambiar, Romnesh De Souza, Vikram Bohra, Ritesh Ramankutty
Stent retrieval system is an established treatment modality in acute ischemic stroke with large vessel occlusion. Here, we describe a complication which occurred during mechanical thrombectomy in three cases where the clot dislodged during retrieval. There was a possibility of the clot getting reinjected into the artery with possible dire consequences.
April 2016: Annals of Indian Academy of Neurology
Sanjith Aaron, N K Shyamkumar, Sunithi Alexander, P Suresh Babu, A T Prabhakar, Vinu Moses, T V Murthy, Mathew Alexander
Even though intravenous thrombolysis with tissue plasminogen activator (IV tPA) is the standard of care in acute ischemic stroke, its use in pregnancy is not clearly defined. Mechanical thrombectomy devices can be an option; however, literature on the use of such mechanical devices in stroke in pregnancy is lacking. Here we describe two cases that developed acute embolic stroke during pregnancy who were successfully treated by mechanical clot retrieval using the Penumbra system 28 (Penumbra Inc., Alameda, California, USA)...
April 2016: Annals of Indian Academy of Neurology
Satoshi Inoue, Atsushi Fujita, Takashi Mizowaki, Yoshito Uchihashi, Ryuichi Kuroda, Seishirou Urui, Eiji Kurihara, Eiji Kohmura
We report a patient with Trousseau syndrome who presented with repeated acute middle cerebral artery (MCA) occlusion, which was successfully treated by performing mechanical thrombectomy. A 66-year-old man with a lung lesion and abdominal lymph node swelling experienced a sudden onset of left hemiparesis. Magnetic resonance angiography (MRA) revealed a right MCA occlusion. Perfusion-weighted imaging revealed reduced cerebral blood flow in the right MCA territory. Complete recanalization of the occluded vessel was achieved by performing mechanical thrombectomy, and his symptoms remarkably disappeared...
June 2016: No Shinkei Geka. Neurological Surgery
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