Keywords:
CNS, Interventional vascular, Neuroradiology brain, Catheter arteriography, CT-Angiography, Arterial access, Thrombolysis, Treatment effects, Acute, Haemodynamics / Flow dynamics, Ischaemia / Infarction
Authors:
A. Borja Consigliere, F. J. Borja Consigliere, A. Lüttich, J. A. Larrea, E. Pardo Zudaire, I. Etxegoien Juaristi, A. Gurruchaga Aguirrezabalaga, J. Arantzeta Lexarreta, J. Masso Romero; San Sebastián/ES
DOI:
10.1594/ecr2013/C-2029
Methods and Materials
We present the results of 10 patients treated in our institution using endovascular Mindframe Capture® stent retrievers for the extraction of distal vessels thrombus in the acute ischemic stroke context.
These 10 patients came to the hospital with neurological symptoms and within the therapeutic window since the symptoms onset.
The stroke code was activated according to established criteria and endovascular therapy was performed.
In our series the time of evolution since the neurological symptoms begun until the stroke code activation,
fluctuated between 45 minutes minimum in a patient with vertebrobasilar territory stroke and 8 hours maximum in a patient affected in the same area.
The patients received neurological evaluation and a CT scan was performed,
including perfusion CT and brain Angio CT according to current protocol.
Out of the 10 total cases,
7 patients presented distal arterial thrombus at the moment of diagnose.
The other three patients did not present distal arterial thrombus at that moment,
but thrombus fragmentation and embolization of these fragments towards distal vessels occurred while attempting to repermeate more proximal arteries; in the first case after thrombolysis,
in the second after extracting the thrombus from the basilar artery and the third one after extracting the thrombus from MCA.
Out of the total,
4 patients presented occlusion in distal branches of posterior circulation and 6 patients presented occlusion in distal branches of anterior circulation.
The affected distal arteries were: P2 segments of posterior cerebral arteries in 3 cases,
superior cerebellar artery in 1 case,
M2-M3 segments of MCA in 5 cases (3 cases in M2,
1 case in M3 and 1 case in M2-M3) and A2 segment of anterior cerebral artery in 1 case.
Six patients had previously received intravenous fibrinolysis (rt-PA).
In 5 of these patients there was a failure in repermeating through fibrinolysis so it was decided to proceed with mechanic thrombectomy as a rescue therapeutic alternative.
In the other case,
intravenous fibrinolysis and mechanic thrombectomy were done as combined therapy.
These ten patients underwent transfemoral arteriography and supraselective catheterism of those cerebral arteries affected by thrombus.
In all cases the stent retriever Mindframe Capture® was used to fulfill the compromised distal branches thrombectomy.
This procedure was done by the interventionist Neuroradiology team of our hospital.