Left “T” carotid artery occlusion with severe clinical deficit

Session

Vall d’Hebron – University Hospital
Stroke Unit and Cerebral Hemodynamics – Barcelona, Spain

How do you go about “chasing the clot”?
At SLICE the goal is to open the debate on even the most difficult cases, where the experience – and questions – of panel and audience can create a productive dialogue with potent take home messages for all.
Join Marc Ribó as he presents the case of an 85-year-old woman who presented with symptom onset of less than 2 hours…see how he chose to treat and the reactions of the panel.
What is the role of the stroke team, and specifically the stroke neurologist during an interventional procedure?
Further questions arising include:
• Is there an age limit for treatment? How does the timeframe from onset and perfusion maps effect treatment? Is this a symptomatic or asymptomatic intracranial hemorrhage?
• How can we improve imaging quality and interpretation? Are CT and CT perfusions faster to accomplish than an MRI? What are “ghost core lesions”? Does low cerebral blood flow on CT perfusion correlate with low canalization rates?
• In terms of contrast use, learn why some say that “Neurons trump nephrons…”?
• What anesthesia is used and how would you control blood pressure? Raised? Lowered?
• In delivering the stent…what techniques can be employed? What does it mean to “massage the clot”?
• Should we choose to chase every thrombus everywhere? When do we say no? How many consecutives passes would you try? Is there a limit and how do you decide?
• Why weren’t balloon occlusion catheters used? Is this related to the patient’s age? Stent retriever technology?
• What are the implications for techniques involved in M1, M2 or M3 occlusions?
• Is there an clinical implication if “staining persists”?
• Can disconnecting the syringe introduce air bubbles into the brain? Does this have a negative effect? What are the clinical consequences?
For the answers to these and other questions, follow this fascinating and passionate case – with the “no holds barred” discussion involving the Expert panel and audience!