Rescue therapy with stent retrievers for thromboembolism during endovascular treatment of intracranial aneurysms / Terapia de resgate com stent para tromboembolismo durante tratamento endovascular de aneurismas intracranianos

ABSTRACT Thromboembolism is the most frequent complication in endovascular treatment of intracranial aneurysms, causing disability and death. As stent retrievers have achieved high rates of arterial recanalization in the management of ischemic stroke, these devices were tested as rescue therapy of thromboembolism during aneurysm embolization. We retrospectively analyzed 10 consecutive patients with transprocedural arterial occlusion, treated with mechanical thrombectomy at a single center. Good angiographic recanalization was achieved in eight cases, mTICI 3, 2b and 2a in five, three and two patients, respectively, without additional complications or any deaths. Five patients showed complete recovery (mRS 0) and all patients showed improvement of disability (average mRS 1.1) over a mean follow-up period of 31 months. Eight patients had good clinical recovery, while two remained with deficits (mRS 3 and 4). The study found that the stent retriever is a valuable, rapid and effective tool for restoring blood flow, improving the safety of endovascular treatment.

RESUMO Tromboembolismo é a complicação mais frequente no tratamento endovascular de aneurismas cerebrais, podendo causar morte ou sequelas. Como os stent retrievers alcançaram altas taxas de recanalização arterial no tratamento do acidente vascular encefálico isquêmico, testamos esses dispositivos para tratar eventos tromboembólicos ocorridos durante a embolização de aneurismas. Foram analisados retrospectivamente 10 pacientes apresentando oclusão arterial transoperatória, tratados com trombectomia mecânica em um único centro. Obtivemos recanalização angiográfica em oito casos, mTICI 3, 2b e 2a em cinco, três e dois pacientes, respectivamente, sem complicações adicionais ou óbito. Cinco casos apresentaram recuperação completa (mRS 0) e todos os pacientes apresentaram melhora dos déficits (mRS médio 1.1) durante acompanhamento médio de 31 meses. Oito pacientes apresentaram boa recuperação clínica, enquanto dois permaneceram com déficits (mRS 3 e 4). O estudo concluiu que stents são uma ferramenta valiosa, rápida e eficaz para restaurar o fluxo sanguíneo, aumentando a segurança do tratamento endovascular.

Endovascular Recanalization of a Thrombosed Native Arteriovenous Fistula Complicated with an Aneurysm: Technical Aspects and Outcomes

OBJECTIVE: To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm. MATERIALS AND METHODS: Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis. RESULTS: The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively. CONCLUSION: Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.

Disconnection of the Rubber Tip of Arrow-Trerotola Percutaneous Thrombolytic Device

A rubber tip disconnection of Arrow-Trerotola percutaneous thrombolytic device (PTD) may occur occasionally. We experienced 5 cases of a rubber tip disconnection among 453 mechanical thrombectomy sessions with the use of PTD. We present a report about these five cases and suggest possible causes for the occurrences.

Pseudo-no-Reflow Phenomenon in Carotid Artery Stenting using FilterWire EX: Successful Recovery by Aspiration Thrombectomy

Distal protection devices such as FilterWire EX have been widely used in carotid artery stenting, however, the large amount of atherothrombotic debris entrapped in the filter could reduce or stop antegrade flow. We present a case of pseudo-no-reflow phenomenon after postdilatation of the stent in a patient with asymptomatic carotid artery stenosis. After several passes using an Export Aspiration catheter, normal flow in the internal carotid artery was restored. Aspiration thrombectomy can successfully recover pseudo-no-reflow phenomenon.

Técnica de trombectomía con catéter Hydrolyser / Intravascular thrombectomic technique with the Hydrolyser catheter

El catéter de trombectomía tipo "Hydrolyser" es un dispositivo que sirve para extraer los trombos agudos y subagudos alojados en venas, arterias y prótesis vasculares, como alternativa o complemento del tratamiento endovascular mediante medicamentos trombolíticos. Se presentan los hallazgos y la experiencia inicial con un paciente con diagnóstico de síndrome de vena cava superiror secundario a fibrosis residual de origen fímico, manejado con este nuevo método

Trombectomía percutánea con catéter tipo hydrolyser como una alternativa en el tratamiento de las trombosis en el Hospital Central Militar / Percutaneous thrombectomy by hydrolyser catheter as an alternative treatment for thrombosis in the Military Central Hospital

Es un estudio in vitro, en tubos de cristal de 0.5 cm de diámetro y con coágulos de 5 hasta 60 días de evolución; se realizo succión con catéter hydrolyser. Ensayo clínico controlado. En 27 pacientes clasificados en dos grupos, a uno se realizó terapia anticoagulante y el otro fue sometido a trombectomía percutánea con catéter hydrolyser (TPCH). Se estuvo la resolución satisfactoria del 100 por ciento en coágulos con evolución hasta de 45 días; los coágulos de 50 a 60 días tuvieron de 90 a 0 por ciento de resolución. El grupo de edad más afectado por trombosis fue el de 51 a 75 años existiendo predominio en el sexo femenino con un 55 por ciento. Los pacientes anticoagulados tuvieron un promedio de encame de 7.75 días y los pacientes tratados con TPCH tuvieron 2.33 días de encame en promedio (p< 0.05). En cuanto a la mejoría clínica, no se observó diferencia estadísticamente significativa entre ambos grupos. En conclusión la trombectomía con catéter hydrolyser es un procedimiento seguro y efectivo, con una rápida trombólisis, prometiendo ser una alternativa más en el tratamiento de las trombosis