Aspiration Thrombectomy of Acute Complete Carotid Bulb Occlusion

doi:10.1097/01.RVI.0000150925.36365.8E

Journal of Vascular and Interventional Radiology

Volume 16, Issue 4, April 2005, Pages 539-542

https://doi.org/10.1097/01.RVI.0000150925.36365.8E Get rights and content

Two patients with acute complete carotid bulb occlusion were treated using intra-arterial aspiration thrombectomy a mean of 3 hours after stroke onset. A slightly angulated 8-F guiding catheter designed for general interventional use was employed to aspirate the thrombus in the carotid artery. Manual aspiration through a 50-mL syringe resulted in effective removal of the thrombus followed by good patency of the internal carotid artery. Aspiration thrombectomy is a simple, feasible and effective rescue procedure for patients with acute complete carotid bulb occlusion.

Section snippets

Patient 1

A 72-year-old woman presented with right hemiparesis and aphasia of 4 hours duration. Her National Institutes of Health Stroke Scale (NIHSS) score was 17. Magnetic resonance (MR) for acute stroke, including diffusionweighted imaging (DWI), T2-weighted imaging, perfusion-weighted imaging (PWI) and three-dimensional time of flight intracranial arteriography (MRA), revealed a large DWI/PWI mismatch (PWI > DWI) in the left cerebral hemisphere and non-visualization of the left ICA. She had no

DISCUSSION

During acute thrombolytic attempts as those used in our two patients who presented with acute stroke, intra-arterial aspiration thrombectomy can be a rescue procedure to restore carotid arterial flow when there is a large thrombi burden at the level of the carotid bulb leading to complete occlusion. Although our study had a limited number of patients, the excellent angiographic results (TIMI 3) and good clinical recovery (NHISS score 4, 2 at the time of discharge; mRS score 2, 1 at 3 months)

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There are more references available in the full text version of this article.

Cited by (28)

In Vitro Testing of a New Aspiration Thrombus Device
2010, Journal of Stroke and Cerebrovascular Diseases
Mechanical thrombectomy can restore blood flow to the brain after acute ischemic stroke, but may be associated with risks, such as breakage of moving parts and clot fragmentation. The aim of this study was to evaluate a new aspiration thrombus device (ATD), the GP ATD, which has no moving parts and extracts clots by suction in a vortex flow pattern.
The GP ATD is used to extract porcine blood clots inserted into the middle cerebral artery (MCA) of a model of the circle of Willis, and from porcine aorta.
The GP ATD is navigable around the acute angles of the circle of Willis model and successfully extracts clots that cause complete occlusion of the MCA. There is a strong correlation between the pressure required for clot extraction (mean 31.8, range 30-34 kPa) and its mass (mean 0.08, range 0.03-0.13 g). Complete clot extraction can be demonstrated by computed tomography scanning. Lysis of a 0.15-g thrombus using alteplase at a concentration of 3.4 μg/mL was more effective when delivered and extracted via the GP ATD than via a catheter without the GP ATD or delivered systemically in our circle of Willis model and extracted without suction (clot mass after extraction 0.07, 0.09, and 0.11 g, respectively). Histologic examination does not show evidence of damage of the arterial wall caused by clot extraction at suction pressures of up to 30 kPa via the GP ATD.
The GP ATD appears to effectively extract blood clots from models of the MCA without significant clot fragmentation and damage to the arterial wall. Further experiments using arteries in situ are required to confirm these findings.
Neuro-rescue during Carotid Stenting
2008, European Journal of Vascular and Endovascular Surgery
Citation Excerpt :
Fracture of the coil of the Merci retriever (first generation device) and detachment of the tip has also been described.10 Aspiration of thrombus from the common carotid artery or cervical portion of the internal carotid artery using diagnostic or guiding catheters (diameter of 4F–7F) has been well described.17–19 When using diagnostic catheters, it is important to use catheters without sideholes, otherwise no vacuum can be obtained.
This paper deals with the treatment of acute neurological complications that may occur during carotid angioplasty with stenting. Endovascular ‘neurorescue’ techniques include mechanical thrombus removal (using retrieval devices, aspiration catheters, and wire or balloon fragmentation) and local and intra-arterial thrombolysis. The treatment of acute thrombosis and dissection during carotid artery and stenting will also be discussed.
Knowledge of these additional skills is essential to increasing the safety of carotid stenting procedures.
A New Device For the Treatment of Thromboembolic Strokes
2007, Journal of Stroke and Cerebrovascular Diseases
We present data concerning the design and testing of a new clot-sucking device for possible use in the extraction of blood clots that arise during thromboembolic strokes. Our data indicate that a jellylike mass of 0.02 g (of an artificial clot) can be removed from plastic tubing using this vortex-creating device, which has an optimal diameter of 1 mm, in conjunction with a 6F arterial catheter that is 110-cm long and using applied suction pressures of about 50 cm Hg.
Management of acute carotid occlusion
2005, European Journal of Vascular and Endovascular Surgery
Long-sheath Introducer-assisted Revascularization (L-SHARE) Technique for Treating Large-vessel Occlusion by a Giant Clot
2023, Internal Medicine
ADAPT FAST study: A direct aspiration first pass technique for acute stroke thrombectomy
2018, Journal of NeuroInterventional Surgery

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This study was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (03-PJ1-PG1-CH06–0001).

None of the authors has identified a potential conflict of interest.

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Aspiration Thrombectomy of Acute Complete Carotid Bulb Occlusion

Section snippets

Patient 1

DISCUSSION

J Vasc Interv Radiol

Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke

Stroke

Results of urgent thrombolysis in patients with major stroke and atherothrombotic occlusion of the cervical internal carotid artery

AJNR Am J Neuroradiol

Recanalization therapies for acute ischemic stroke

Semin Neurol

Intraarterial suction thrombectomy in acute stroke

AJNR Am J Neuroradiol