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AJNR - American Journal of Neuroradiology

Published ahead of print on November 1, 2007
doi: 10.3174/ajnr.A0790

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Occlusion Length Is a Crucial Determinant of Efficiency and Complication Rate in Thrombectomy for Acute Ischemic Stroke

J. Gralla^a, M. Burkhardt^a, G. Schroth^a, M. El-Koussy^a, M. Reinert^b, K. Nedeltchev^c, J. Slotboom^a and C. Brekenfeld^a

^a Department of Interventional and Diagnostic Neuroradiology, University of Bern, Bern, Switzerland
^b Department of Neurosurgery, University of Bern, Bern, Switzerland
^c Department of Neurology, University of Bern, Bern, Switzerland

View larger version (33K): [in this window] [in a new window]   Fig 1. Comparison of distal devices. The Merci device (A) has a coil-like shape; the Catch device (B) has significantly more filaments forming its basketlike shape than the BCR Roadsaver device (C) with its complex snarelike shape. D, The device is delivered using a microcatheter and is unsheathed behind the clot, where force is applied to the distal base of the thrombus.

View larger version (64K): [in this window] [in a new window]   Fig 2. Magnified image of initial 10-mm thrombus; the microcatheter (*) is positioned proximal to the thrombus (]) with the device unsheathed (upper and lower markers >) distal to the thrombus (A). B–D, During initial retrieval, the device partially catches the thrombus without significant elongation of the vessel. C and F, Minor dislocation of thrombus and device is visible at the junction of the lingual and maxillary arteries. E, Elongation of the thrombus in proximity to the balloon catheter (open arrow) illustrates the effect of the additional proximal aspiration. Total retrieval was achieved.

View larger version (72K): [in this window] [in a new window]   Fig 3. Retrieval of the 10-mm thrombus. A, The distal device (upper and lower markers <) enters the thrombus. B and C, Approximately half of the thrombotic material is carried within the device; the other half is either pushed sideways to the microcatheter (*) or proximal to the device and is prone to collateral flow (D). E, The supplementary proximal aspiration sucks the entire thrombus from the device into the balloon catheter (open arrow) to achieve total recanalization.

View larger version (38K): [in this window] [in a new window]   Fig 4. A, During the retrieval attempt of the 40-mm thrombus, the device is unsheathed distal to the thrombus. B, The device (upper and lower markers <) enters the thrombus. C–E, The thrombotic material is progressively compressed between the device and the microcatheter (*).

View larger version (39K): [in this window] [in a new window]   Fig 5. The 40-mm thrombus (]) is initially mobilized within the carrying vessel (A) and partially compressed sideways to the microcatheter (B). C, The thrombus enters the balloon catheter (open arrow); compression of the thrombus causes the distal part to stick at the tip of the balloon catheter. The thrombus is elongated (D) and finally fractures with consequent thromboembolization () into other major vessels (E). A major potion of the thrombus is retrieved to the balloon catheter.

View larger version (73K): [in this window] [in a new window]   Fig 6. A, The device (upper and lower markers <) is unsheathed distal to the 40-mm thrombus. B and C, During the retrieval attempt, the device enters the compressed thrombus, and the pulling force causes marked elongation of the carrying vessel. The device finally slips through the thrombus catching only a minor fragment (D), which is retrieved together with the microcatheter (*) to the balloon catheter (open arrow; E).