0000000000187724
AUTHOR
Carolin Brockmann
Optimizing endovascular stroke treatment: removing the microcatheter before clot retrieval with stent-retrievers increases aspiration flow
BackgroundFlow control during endovascular stroke treatment with stent-retrievers is crucial for successful revascularization. The standard technique recommended by stent-retriever manufacturers implies obstruction of the respective access catheter by the microcatheter, through which the stent-retriever is delivered. This, in turn, results in reduced aspiration during thrombectomy. In order to maximize aspiration, we fully retract the microcatheter out of the access catheter before thrombectomy—an approach we term the ‘bare wire thrombectomy’ (BWT) technique. We verified the improved throughput with systematic in vitro studies and assessed the clinical effectiveness and safety of this metho…
Endovascular stentectomy using the snare over stent-retriever (SOS) technique: An experimental feasibility study
PLoS one 12(5), e0178197 (2017). doi:10.1371/journal.pone.0178197
Under Pressure: Comparison of Aspiration Techniques for Endovascular Mechanical Thrombectomy.
BACKGROUND AND PURPOSE: Blood flow should be interrupted during mechanical thrombectomy to prevent embolization of clot fragments. The purpose of our study was to provide a handy overview of the most common aspiration devices and to quantify their flow characteristics. MATERIALS AND METHODS: We assessed volumetric flow rates generated by a 60-mL VacLok vacuum pressure syringe, a Pump MAX aspiration pump, and a Dominant Flex suction pump connected to the following: 1) an 8F long sheath, 2) an 8F balloon-guide catheter, 3) an ACE 64 distal aspiration catheter, and 4) an AXS Catalyst 6 Distal Access Catheter. We used a water/glycerol solution, which was kept at a constant temperature of 20°C (…
Graph-matching based CTA.
Separating bone, calcification, and vessels in computer tomography angiography (CTA) allows for a detailed diagnosis of vessel stenosis. This paper presents a new, graph-based technique that solves this difficult problem with high accuracy. The approach requires one native data set and one that is contrast enhanced. On each data set, an attributed level-graph is derived and both graphs are matched by dynamic programming to differentiate between bone, on one hand side, and vessel/calcification on the other hand side. Lumen and calcified regions are then separated by a profile technique. Evaluation is based on data from vessels of pelvis and lower extremities of elderly patients. Due to subst…
Image-Guided Transcranial Doppler Ultrasound for Monitoring Posthemorrhagic Vasospasms of Infratentorial Arteries: A Feasibility Study
Background A considerable number of patients with subarachnoid hemorrhage (SAH) develop vasospasms of the infratentorial arteries. Transcranial Doppler sonography (TCD) is used to screen for vasospasm. In this study, we used a technical modification that combines TCD with an image guidance device that the operator can use to navigate to the ultrasonic window and to predefined intracranial vascular targets. Our aim was to analyze the feasibility, spatial precision, and spatial reproducibility of serial image-guided TCD of infratentorial and—for comparison—supratentorial arteries in the clinical setting of monitoring for vasospasm after SAH. Methods The study included 10 SAH patients, who eac…
Influence of carotid tortuosity on internal carotid artery access time in the treatment of acute ischemic stroke
Purpose Carotid artery anatomy is thought to influence internal carotid artery access time (ICA-AT) in patients requiring mechanical thrombectomy for acute ischemic stroke. This study investigates the association between ICA-AT and carotid anatomy. Material and methods Computed tomography angiography (CTA) data of 76 consecutive patients presenting with acute ischemic stroke requiring mechanical thrombectomy for middle cerebral artery or carotid T occlusion were evaluated. The supraaortic extracranial vasculature was analyzed regarding take-off angles and curvature of the affected side. Digital subtraction angiography data were primarily analyzed regarding ICA-AT and secondarily regarding r…