Mechanical thrombectomy in distal intracranial occlusions

Recorded cases from SLICE 2018

2 october 2018 – 16:10

By René CHAPOT

A drama in 8 passes

A 44-year-old female patient arrives from a local hospital with right hemiparesis and aphasia, NIHSS score 16 with an occlusion of the common carotid artery. IV tPA is not administered due to use of Eliquis from an earlier occlusion. How would you treat?

Prof. René Chapot from Essen, Germany leads us through this dramatic case, as we follow his treatment choices step-by-step and share in the charged discussion with the expert panel. Early in the procedure, after discovering that the clot has moved and seeing diffuse clotting and occlusions, Prof. Chapot chooses to proceed immediately by clot removal, an intervention which required 8 passes.

Was waiting an option? Is this approach dangerous? What challenges are present for the collaterals when there are occlusions of both the MCA and ACA?  What type of anesthesia and what drugs would you use, especially considering potential bleeding risk? Can lithics be added during thrombectomies? What are the tools and techniques of clot removal and what techniques are employed to minimize the danger of rupture? When – and why – was carotid stenting performed? Finally, when do you choose to continue or to stop? Would the patient, who at follow-up was NIHSS 11, have done just as well as if not treated? How would you have managed this patient? Enter the discussion here…

 

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