Direct Carotid Puncture for Endovascular Thrombectomy

Recorded cases from SLICE 2018

3 october 2018 – 13:30

By René CHAPOT

When direct carotid puncture is needed

Twenty-seven minutes after groin puncture, passing the catheter remains impossible in a patient with an M2 occlusion, venous thrombosis and insular ischemia. Follow René Chapot as he demonstrates an approach rarely used today – deciding to go for direct carotid puncture.

How long did it take before choosing to switch from femoral to carotid? Why choose local aspiration and a stentriever in this procedure or emphasize the importance of a “J” shape? What does it mean to the operator when the stentriever “jumps”? Can the number of failed passes tell us something about the compactness of the clot?

Finally, R. Chapot discusses closing the carotid puncture, sparking a discussion on closure devices, such as Perclose ProGlide™ or Angio-seal™ and the role of compression. Learn why he chooses the Angio-seal™ device despite limited data and the risk of embolization. With all these complications, the age of the patient, the fact that symptoms – such speech impairment – occurred the day before the intervention, should this patient be treated at all? Is it still possible to remove the clot even after several passes?

Find out here…

 

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