Mechanical thrombectomy for treatment of acute ischemic stroke

102 Pages·2017·7.16 MB·English

4/14/2017
MECHANICAL
THROMBECTOMY
FOR TREATMENT OF
ACUTE ISCHEMIC
STROKE
DANIELLE SORTE, MD
ASSISTANT PROFESSOR UNIVERSITY OF NEW MEXICO
RADIOLOGY AND NEUROSURGERY
WHAT YOU NEED TO KNOW ABOUT STROKE
5
1
# 795,000 40%
cause of #
disability
among
americans each year
adults in are large vessel
suffer a stroke
the US occlusion
cause
KILLS 128,000 EVERY 40
of death
among
SECONDS
people a year. That’s about
adults
one out of every 19 deaths someone has a stroke in the US
Statistics from the American Heart Association/American Stroke Association, World Health Organization and Centers for DiseaseControl and Prevention. © 2015 1/13DS6139
STROKE DISEASE STATE
795,000 STROKES PER YEAR U.S.*
ISCHEMIC STROKE: 87%* HEMORRHAGIC STROKE: 13%*
Acute Ischemic Stroke
Brain Aneurysm Brain AVM
*National Stroke Association. (2012). Stroke 101 Fact Sheet.Retrieved from National Stroke Association: http://www.stroke.org/site/PageServer?pagename=factsheets
ACUTE ISCHEMIC STROKE TREATMENT OPTIONS
Medical Management Mechanical Thrombectomy
• IV t-PA is the clot busting drug used with • This procedure uses a stent retriever that is
stroke patients placed in the occluded vessel through a
catheter placed in the groin
• Patients must be within the time window
of 0-4.5 hours from symptom onset • The time window for mechanical
thrombectomy is up to 8 hours from
• There are other contraindications symptom onset*
associated with the use of the drug as well
• If the patient fails IV t-PA or is ineligible for IV
t-PA , they may be eligible for mechanical
thrombectomy*
LARGE VESSEL OCCLUSIONS
SCOPE OF THE PROBLEM
▪ Common: 40-50% of all ischemic stroke
▪ Severe: 5x higher mortality, 3-fold reduction in good outcome
▪ Respond poorly to intravenous thrombolytic (tPA)
▪ Successful opening of occlusion by Intravenous tPA:
▪ Middle Cerebral Artery: 35%
▪ Carotid Terminus: Less than 10%
CASE 1
▪ 67-year-old male who presented with left cervical ICA occlusion and MCA occlusion with an NIH stroke scale of 22. After receiving IV tPA, he
improved to an NIH stroke scale of 3. Subsequently at 0110 hrs, this exam deteriorated again and he had an NIH stroke scale of 20. Therefore,
the decision was made to perform an MRI and MR perfusion determine if there was diffusion/perfusion mismatch. After detection of a large
penumbra, the decision was made to proceed with mechanical thrombectomy.