When one pass is not enough…

5 october 2016 – 15:45

Gui de Chauliac University Hospital – Department of Neuroradiology
Montpellier, France
Team led by Alain Bonafé and Vincent Costalat

Led by Omer Eker, follow the treatment of a 62-year-old-male who wakes up with a stroke and exhibits transient facial symmetry. Arriving at the hospital four hours after onset with an NIHSS score of 7, we see the MRI evaluation and enter the angiosuite where the patient is treated for an R1 isolated MCA occlusion by mechanical thrombectomy.

What tools and devices were used? How was the procedure performed? Why did the operators try thrombus aspiration, only to change to a stentriever device? With the first and second pass failing to retrieve the clot, with an occlusion still seemingly present, listen as the experts in the audience debate whether vasospasm has occurred. How can we be sure that the clot is in the catheter? Learn a “pinching technique” is recommended when using with a stentriever as a “first intention”. Or, when after more than 15 minutes, one of the branches is still occluded…What to do? Should the strategy change? Do they?

And even though the final result was excellent, the discussion is far from over, with Raul Nogueira asking if anyone would give a heparin bolus, while others wonder whether aspiration was given a reasonable chance, suggesting that “You probably should give your first tool more than once”.
What do you think? Join the discussion now…

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