Overcoming the black box of aspiration thrombectomy in acute ischemic stroke: An early clinical experience of using contrast injections to understand clot-catheter interactions.

IF 1.5 4区 医学 Q4 CLINICAL NEUROLOGY
Elliott Pressman, Sheyar Amin, Kunal Vakharia, Waldo R Guerrero, Shail Thanki, Adnan H Siddiqui, Maxim Mokin
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引用次数: 0

Abstract

BackgroundFactors responsible for failure of aspiration thrombectomy in patients with acute ischemic stroke are poorly understood. In order to examine catheter-clot interactions, we modified our current aspiration thrombectomy technique by performing contrast injections near the tip of the aspiration catheter prior to the initiation of aspiration thrombectomy.MethodsSmall volume injections of contrast were performed using a microcatheter positioned inside the aspiration catheter immediately proximal to the occlusion site. Continuous fluoroscopy during the entire duration of each aspiration pass was recorded. We report our initial results with this new technique and examine potential associations of patterns of contrast behavior with procedural success of each thrombectomy pass.ResultsSeventeen patients were included in final analysis, consisting of 24 total aspiration thrombectomy passes. Microcatheter injections showed no safety concerns. Three angiographic patterns of contrast behavior near the aspiration catheter tip were observed: "occlusive" with no forward contrast flow, "side branch opacification" and "anterograde opacification" with anterograde flow. Movement of the contrast column during aspiration thrombectomy depended on the degree of aspiration catheter redundancy. Manual reduction of excessive catheter turns and higher position of long guide sheath at the petrous or cavernous segments seemed to improve contrast clearance and aspiration force.ConclusionsThis initial experience indicates that multiple complex factors may affect success rates of aspiration thrombectomy. The technique of microcatheter injection near the occlusion site may prove helpful in optimizing the existing aspiration thrombectomy techniques.

克服急性缺血性卒中抽吸取栓的黑盒子:使用造影剂注射了解血栓-导管相互作用的早期临床经验。
背景:急性缺血性脑卒中患者吸入性取栓失败的原因尚不清楚。为了检查导管-凝块的相互作用,我们修改了目前的吸入性取栓技术,在吸入性取栓开始前在吸入性取栓导管尖端附近进行造影剂注射。方法在闭塞部位近端抽吸导管内置入微导管进行小体积注射造影剂。记录每次抽吸期间的连续透视情况。我们报告了这项新技术的初步结果,并检查了对比行为模式与每次取栓成功的潜在关联。结果17例患者纳入最终分析,包括24个总抽吸取栓通道。微导管注射无安全问题。在导管尖端附近观察到三种造影剂表现:“闭塞”无正向造影剂血流,“侧支混浊”和“顺行性混浊”伴顺行性血流。吸入性取栓过程中造影柱的移动取决于吸入性导管冗余的程度。手动减少过多的导管转数和在岩状或海绵状节段增加长引导鞘的位置似乎可以提高造影剂清除率和吸吸力。结论初步经验表明,多种复杂因素可能影响抽吸取栓成功率。闭塞部位附近微导管注射技术可能有助于优化现有的吸入性取栓技术。
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来源期刊
Interventional Neuroradiology
Interventional Neuroradiology CLINICAL NEUROLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
3.60
自引率
11.80%
发文量
192
审稿时长
6-12 weeks
期刊介绍: Interventional Neuroradiology (INR) is a peer-reviewed clinical practice journal documenting the current state of interventional neuroradiology worldwide. INR publishes original clinical observations, descriptions of new techniques or procedures, case reports, and articles on the ethical and social aspects of related health care. Original research published in INR is related to the practice of interventional neuroradiology...
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