Recorded cases from SLICE 2018
3 october 2018 – 15:00
By René CHAPOT
Finding more than an MCA occlusion
René Chapot (Germany) presents this challenging case of an 81-years-old female with a wakeup stroke. Quick arrival at the comprehensive stroke center: no IV tPA, M1 occlusion, good collaterals and a low NIHSS score – is this patient a candidate for thrombectomy?
Do the excellent collaterals offer you more time? Would this patient have qualified to enter the DAWN trial – and why? After the WAKE-UP trial, what should the approach to IV lithics be? In evaluating the patient, can we be “too reliant on CT perfusion”? How do we interpret the NIHSS score and the suspected occlusion site?
From the beginning the interaction between R. Chapot and the expert panel and audience is revealing…questions and clinical suggestions by R. Nogueira (USA), M. J. Alexander (USA), C. Arquizan (France) or T.G. Jovin (USA) animate the step-by-step procedure: Is the patient diabetic? Could this be intracranial atherosclerosis disease – and why? Should you use general anesthesia (GA) or conscious sedation (CS)?
What should make you suspicious of an older or chronic occlusion? What imaging to use? How important is angiography? What devices to employ? Microcatheters? What is the efficiency of aspiration or how to prevent no flow? What drugs? Reopro? Bleeding risk?
How would you treat a chronic occlusion involving the MCA? Join the discussion here….