E-005 Emergent mechanical thrombectomy and outcome of acute ischaemic stroke patients who presented with internal carotid artery terminus occlusion due to thrombus-a case series

2013 ◽  
Vol 5 (Suppl 2) ◽  
pp. A35-A35
Author(s):  
Y Lodi ◽  
V Reddy ◽  
A Devasenapathy ◽  
G Petro ◽  
K Sethi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Stroke Patients

scholarly journals Emergent extracranial internal carotid artery stenting and mechanical thrombectomy in acute ischaemic stroke

2015 ◽  
Vol 21 (2) ◽  
pp. 205-214 ◽  
Author(s):  
Ankit Mishra ◽  
Hannah Stockley ◽  
Tony Goddard ◽  
Hemant Sonwalker ◽  
Siddhartha Wuppalapati ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ischaemic Stroke ◽  
Cerebral Artery ◽  
Acute Ischaemic Stroke ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Extracranial Internal Carotid Artery ◽  
Mean Time

Objective Tandem occlusions involving both the extracranial internal carotid artery (ICA) and an intracranial artery typically respond poorly to intravenous (IV) tissue plasminogen activator (t-PA). We retrospectively review our experience with proximal ICA stenting and stent-assisted thrombectomy of the distal artery. Methods The data included patients that underwent carotid stenting and mechanical thrombectomy between 2012–2013. Radiographic, clinical, and procedural data were drawn from case notes, imaging records and discharge reports. Clinical outcomes were evaluated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRs). Results Seven patients, with a mean age of 66.4 years and a mean admission NIHSS of 18.3, underwent this procedure and were included. Each presented with an occlusion of the proximal ICA, with additional occlusions of the ICA terminus ( n = 3), middle cerebral artery ( n = 5), or anterior cerebral artery ( n = 1). Recanalisation of all identified occlusions was achieved in all patients, with a Thrombolysis in Myocardial Infarction (TIMI) score of 3 and a Thrombolysis in Cerebral Infarction (TICI) score >2b achieved in each case. Mean time from onset of stroke symptoms to recanalisation was 287 min; mean time from first angiography to recanalisation was 52 min. Intracranial haemorrhages occurred in two patients, with no increase in NIHSS. There were no mortalities. Mean NIHSS at discharge was 4.9, and mRs at 90 days was one in all patients. Conclusions Treatment of tandem extracranial ICA and intracranial occlusions in the setting of acute ischaemic stroke with extracranial carotid artery stenting followed by adjunctive intracranial mechanical thrombectomy is both safe and effective, but further evaluation of this treatment modality is necessary.

scholarly journals Surgery after Anticoagulation in Stroke Patients with Nonatherosclerotic Internal Carotid Artery Thrombus: A Clinicopathological Case Series

2010 ◽  
Vol 29 (3) ◽  
pp. 304-307 ◽  
Author(s):  
Julian Bösel ◽  
Antje S. Kasper ◽  
Wilko Weichert ◽  
Georg Bohner ◽  
Stephan J. Schreiber ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Case Series ◽  
Stroke Patients

scholarly journals Flow-diverter reconstruction of an intracranial internal carotid artery dissection during thrombectomy for acute ischaemic stroke

2020 ◽  
Vol 13 (1) ◽  
pp. e231612
Author(s):  
Laura Ludovica Gramegna ◽  
Analía Cardozo ◽  
Edgar Folleco ◽  
Alejandro Tomasello
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection ◽  
Flow Diverter Stent

Intracranial carotid artery dissections are challenging, as there are no specific guidelines for their treatment, and most research suggests solutions for treating those involving extracranial vessels. We describe a patient with an acute ischaemic stroke within the territory of the right internal carotid artery, who was found to have intracranial carotid artery dissection during the thrombectomy procedure. The dissected lumen was successfully reconstructed via deployment of a Derivo flow-diverter stent. A balloon-assisted ‘jacking’ manoeuvre, in which a balloon is partially inflated at the beginning of the dissection to serve as leverage, was used to overcome the challenge of navigating the microcatheter tip through the stenosis proximal to the dissection. This case demonstrates the feasibly and safety of stenting with a flow diverter in a patient with internal carotid artery dissection; however, further studies are needed to confirm this finding.

scholarly journals Mechanical thrombectomy in acute ischaemic stroke patients with pre-interventional intracranial haemorrhage following intravenous thrombolysis

2021 ◽  
pp. 197140092110091
Author(s):  
Hanna Styczen ◽  
Matthias Gawlitza ◽  
Nuran Abdullayev ◽  
Alex Brehm ◽  
Carmen Serna-Candel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intracranial Haemorrhage ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion

Background Data on outcome of endovascular treatment in patients with acute ischaemic stroke due to large vessel occlusion suffering from intravenous thrombolysis-associated intracranial haemorrhage prior to mechanical thrombectomy remain scarce. Addressing this subject, we report our multicentre experience. Methods A retrospective analysis of consecutive acute ischaemic stroke patients treated with mechanical thrombectomy due to large vessel occlusion despite the pre-interventional occurrence of intravenous thrombolysis-associated intracranial haemorrhage was performed at five tertiary care centres between January 2010–September 2020. Baseline demographics, aetiology of stroke and intracranial haemorrhage, angiographic outcome assessed by the Thrombolysis in Cerebral Infarction score and clinical outcome evaluated by the modified Rankin Scale at 90 days were recorded. Results In total, six patients were included in the study. Five individuals demonstrated cerebral intraparenchymal haemorrhage on pre-interventional imaging; in one patient additional subdural haematoma was observed and one patient suffered from isolated subarachnoid haemorrhage. All patients except one were treated by the ‘drip-and-ship’ paradigm. Successful reperfusion was achieved in 4/6 (67%) individuals. In 5/6 (83%) patients, the pre-interventional intracranial haemorrhage had aggravated in post-interventional computed tomography with space-occupying effect. Overall, five patients had died during the hospital stay. The clinical outcome of the survivor was modified Rankin Scale=4 at 90 days follow-up. Conclusion Mechanical thrombectomy in patients with intravenous thrombolysis-associated intracranial haemorrhage is technically feasible. The clinical outcome of this subgroup of stroke patients, however, appears to be devastating with high mortality and only carefully selected patients might benefit from endovascular treatment.

Management of Mobile Thrombus With Distal Protection Devices During Carotid Artery Angioplasty: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Salomon Cohen-Cohen ◽  
Giuseppe Lanzino ◽  
Waleed Brinjikji ◽  
Adam Arthur ◽  
Mark Bain ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Video Production ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Cerebral Angiogram ◽  
Protection Devices

Abstract Embolic protection devices (EPDs) have become a standard of care during internal carotid artery revascularization.1,2 This video is about a 57-yr-old-male who presented with a wake-up stroke with a left hemispheric syndrome. Head computed tomography angiography (CTA) revealed tandem occlusions of the proximal left internal carotid artery (ICA) and of the distal left middle cerebral artery (MCA) with an ASPECT (Alberta Stroke Program Early CT Score) score of 6. The patient underwent a cerebral angiogram and was treated with balloon angioplasty with a distal EPD and mechanical thrombectomy. The EPD became occluded with thrombus from the ICA and was retrieved through a 6-Fr Sofia (MicroVention) under continuous aspiration. Successful revascularization of the proximal ICA and distal MCA was achieved. No procedure-related complications occurred, and the patient's neurological exam improved. Tandem occlusions can occur in up to 15% of strokes. The optimal treatment can be controversial, but mechanical thrombectomy and ICA revascularization with a distal EPD appear to be safe and effective in selected patients.3 Consent was obtained for the procedure and for the video production.

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