Journal article
Mechanical Thrombectomy of Acutely Occluded Flow-Diverters – Neuroendovascular Surgical Technique Demonstration: 2-Dimensional Operative Video
Operative neurosurgery (Hagerstown, Md.), Vol.19(2), pp.E176-E177
08/01/2020
DOI: 10.1093/ons/opz345
PMID: 31768547
Abstract
Abstract Flow-diversion with pipeline embolization devices (PED, Medtronic, Dublin, Ireland) is widely used for embolization of complex intracranial aneurysms.1 In-stent thrombosis can be a dreadful complication after PED deployment. Intra-arterial glycoprotein IIb-IIIa inhibitors and intravenous tissue plasminogen activator have been used in an attempt to achieve recanalization.2 However, large clots may not be effectively dissolved by pharmacological agents, thus requiring mechanical thrombectomy (MT).3 Our group recently published the first technical report on successful MT of acutely occluded PEDs in 2 patients.4 Here, we showcase the successful MT of a patient who sustained acute in-stent PED thrombosis. Informed written consent was obtained. In this case, we combined stentriever and contact aspiration thrombectomy techniques. We highlight important pitfalls and tips to prevent PED displacement, removal or vessel injury during endovascular manipulation. The most important consideration is to deploy the distal end of the stentriever inside the PED but also as distally as possible. Thus, correct apposition and alignment of the distal markers of both devices is performed under “native” unsubstracted fluoroscopic view (for better PED visualization) before MT. In this surgical video we describe the technique in detail.
Details
- Title: Subtitle
- Mechanical Thrombectomy of Acutely Occluded Flow-Diverters – Neuroendovascular Surgical Technique Demonstration: 2-Dimensional Operative Video
- Creators
- Jorge A Roa - Department of Neurology and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IowaDavid M Hasan - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IowaEdgar A Samaniego - Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- Operative neurosurgery (Hagerstown, Md.), Vol.19(2), pp.E176-E177
- DOI
- 10.1093/ons/opz345
- PMID
- 31768547
- ISSN
- 2332-4252
- eISSN
- 2332-4260
- Language
- English
- Date published
- 08/01/2020
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984070114902771
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