Stroke Game 6 - SLICE Worldwide 2021
STROKE GAME
6 / 14 episodes
Shani Avnery Kalmanovich , Vincent COSTALAT , Tommy Andersson , Marc Ribo , Pasquale Mordasini , Arkadiusz Kacała , Lina Palaiodimou , Demetrius Lopes
Stroke Game 1: Isolated Cervical Occlusion Management complicated of hemodynamic failure - SLICE Worldwide 2021
Shani Avnery Kalmanovich , Vincent COSTALAT , Federico Cagnazzo , Wim van Zwam , Marc Ribo , Tudor Jovin , Johanna Fifi
Stroke Game 3 ep.1/3: - SLICE Worldwide 2022
Shani Avnery Kalmanovich , Vincent COSTALAT , Federico Cagnazzo , Marc Ribo , Tudor Jovin , Johanna Fifi
Stroke Game 3 ep.2/3: - SLICE Worldwide 2022
Shani Avnery Kalmanovich , Vincent COSTALAT , Federico Cagnazzo , Wim van Zwam , Marc Ribo , Tudor Jovin , Johanna Fifi
Stroke Game 3 ep.3/3: - SLICE Worldwide 2022
Shani Avnery Kalmanovich , Vincent COSTALAT , Federico Cagnazzo , Wim van Zwam , Marc Ribo , Pasquale Mordasini , Demetrius Lopes , CHRISTOPHE COGNARD , Jane Khalife , Alexander Salerno
Stroke Game 2: Very late stroke - SLICE Worldwide 2021
Shani Avnery Kalmanovich , Vincent COSTALAT , Demetrius Lopes , Eitan Abergel , CHRISTOPHE COGNARD , Francisco José Mont' Alverne
Stroke Game 1 ep.1/2: Pediatric Case - SLICE Worldwide 2022
Shani Avnery Kalmanovich , Vincent COSTALAT , Wim van Zwam , Demetrius Lopes , Eitan Abergel , CHRISTOPHE COGNARD , Francisco José Mont' Alverne , Johanna Fifi
Stroke Game 1 ep.2/2: Pediatric Case - SLICE Worldwide 2022
Vincent COSTALAT , Demetrius Lopes , Tudor Jovin , Mayank Goyal , Raul Nogueira , Johanna Fifi
Stroke Game 2 ep.1/3: Minor stroke patients - SLICE Worldwide 2022
Vincent COSTALAT , Demetrius Lopes , Tudor Jovin , Mayank Goyal , Raul Nogueira , Johanna Fifi
Stroke Game 2 ep.3/3: Minor Stroke - SLICE Worldwide 2022
Vincent COSTALAT , Demetrius Lopes , Tudor Jovin , Mayank Goyal , Raul Nogueira , Johanna Fifi
Stroke Game 2 ep.2/3: How to face an ICAD? - SLICE Worldwide 2022
CHRISTOPHE COGNARD , Eitan Abergel , Federica Rizzo , Javier Lagos Servellon , Marc Ribo , Pasquale Mordasini , Shani Avnery Kalmanovich , Vincent COSTALAT
Stroke Game 3: Posterior circulation stroke - SLICE Worldwide 2021
Davi Haddad , Fenne Vandervorst , Shani Avnery Kalmanovich , Tommy Andersson , Vincent COSTALAT , Wim van Zwam
Stroke Game 4: Vertebral tandem occlusion - SLICE Worldwide 2021
Shani Avnery Kalmanovich , Vincent COSTALAT , Federico Cagnazzo , Wim van Zwam , Marc Ribo , Demetrius Lopes , Ameer Hassan , Franz Bozsak , Vedran Župančić , Hani Ridwan , Tommy Andersson , Tudor Jovin
Stroke Game 5: Failed Thrombectomy - SLICE Worldwide 2021
Greg Albers , Manuel Alberto Correia , Francisco José Mont' Alverne , Federico Cagnazzo , Mayank Goyal , Shani Avnery Kalmanovich , Danijel Trajkovic , Tudor Jovin , Vincent COSTALAT , Wim van Zwam
Stroke Game 6 - SLICE Worldwide 2021
Stroke Game
Replay Day 2 - Slice WW 2021 - Stroke Game 6
Chronic carotid revascularization – its pros, cons and the technique
Presentations of case resolutions in the form of a “serious game”. Step by step, from the emergency call to the resolution on high fidelity silicon models in the angiosuite, the members of the SLICE Academy will work along with faculty members to solve these real cases reconstitutions.
DIAGNOSIS:
CTP in chronic asymptomatic ICA occlusion:
- Tmax delayed
- MTT, CBV, CBF – normal
CTP in chronic symptomatic ICA occlusion (hemodynamic changes due to hypoperfusion):
- Tmax delayed
- MTT increased
- CBV and CBF decreased (but less pronounced than in typical acute stroke)
Sometimes severe stenosis (near-occlusion) can present as an occlusion, so to be sure, you should confirm the diagnosis in DSA. DSA may reveal “string sign” in that cases.
Be aware of carotid “pseudostring sign” from vasa vasorum collaterals in case of total chronic carotid occlusion (its presence is a positive predictive value of successful recanalization).
SYMPTOMS:
Patients may be: asymptomatic, periodically symptomatic with hemispheric neurological symptoms (symptoms induced during physical effort) or constantly symptomatic.
Stress-test with acetazolamide (mimicking physical effort) is usually performed under scintigraphy (quantitative method), but may also be used during MRI imaging.
Patient may have cognitive impairment in neuropsychological testing due to focal cognitive deficits attributed to affected hemisphere.
TECHNIQUE:
- Start with 3D-angiography of the stump
- If there is vasa vasorum supplying the lumen of ICA at some point above the occlusion, perform the intramural dissection:
- you plug the BCG in the stump of ICA, then you start crossing the lesion with diagnostic 5F catheter and long microwire with microcatheter on inflated BCG (it gives you extra support)*
*procedure is safe until this moment (no connection to the patent lumen of ICA above = no risk of distal emboli neither reperfusion injury)
- you have to re-enter to the proper lumen of ICA*
*continuing with intramural dissection on the level of ophthalmic branch of ICA can jeopardize cerebral and ophthalmic supply – re-entry point should be below the ophthalmic segment
- once you manage to enter the proper lumen of ICA, aspire with small 3cc syringe to see whether you have blood backflow and then do microangiography (on BCG deflated) to confirm the proper position of the microcatheter in the true lumen
- push 300 cm wire into the MCA and do the over-the-wire-exchange (remove microcatheter and 5F catheter)
- perform “full metal jacket” reconstruction of ICA on bare wire (with overlap of the stents, under inflated BCG) :
- start with the antegrade implantation of normal carotid stents up to the skull base
- once you placed your stents at the level of cervical portion of ICA, go up with BCG to not block the flow through ECA any more
- perform PTA of the channel at the level of re-entry point
- do the retrograde intracranial reconstruction with flow diverters (another option is the usage of carotid coronary stents)
- once you overlap all the stents, you perform the control run (on BCG deflated)
- evaluate the patency of intracranial vessels and confirm good apposition of the stents by performing vaso-CT
Note: if it is possible to stay from the beginning in the true lumen, it is even better (no need for re-entry, lower rate of re-occlusion, better chance of reendothelialization of created channel).
CRUCIAL POINTS:
The keys are:
- qualification of the patient to the treatment (hypoperfusion without infarct core)
- preloading with drugs (patients prepared on heparin during 10 days prior the intervention, DAPT or cangrelor iv. during the procedure)
- postoperative treatment : medications + blood pressure surveillance (maintenance of low blood pressure after the procedure* and antiplatelet therapy)
*before the revascularization high blood pressure is recommended
Please note that there is a need for further investigation and safety evaluation of the procedure.
0 resource for this video
{{items.total}} comments comment
STROKE GAME
6 / 14 episodes
Shani Avnery Kalmanovich , Vincent COSTALAT , Tommy Andersson , Marc Ribo , Pasquale Mordasini , Arkadiusz Kacała , Lina Palaiodimou , Demetrius Lopes
Stroke Game 1: Isolated Cervical Occlusion Management complicated of hemodynamic failure - SLICE Worldwide 2021
Shani Avnery Kalmanovich , Vincent COSTALAT , Federico Cagnazzo , Wim van Zwam , Marc Ribo , Tudor Jovin , Johanna Fifi
Stroke Game 3 ep.1/3: - SLICE Worldwide 2022
Shani Avnery Kalmanovich , Vincent COSTALAT , Federico Cagnazzo , Marc Ribo , Tudor Jovin , Johanna Fifi
Stroke Game 3 ep.2/3: - SLICE Worldwide 2022
Shani Avnery Kalmanovich , Vincent COSTALAT , Federico Cagnazzo , Wim van Zwam , Marc Ribo , Tudor Jovin , Johanna Fifi
Stroke Game 3 ep.3/3: - SLICE Worldwide 2022
Shani Avnery Kalmanovich , Vincent COSTALAT , Federico Cagnazzo , Wim van Zwam , Marc Ribo , Pasquale Mordasini , Demetrius Lopes , CHRISTOPHE COGNARD , Jane Khalife , Alexander Salerno
Stroke Game 2: Very late stroke - SLICE Worldwide 2021
Shani Avnery Kalmanovich , Vincent COSTALAT , Demetrius Lopes , Eitan Abergel , CHRISTOPHE COGNARD , Francisco José Mont' Alverne
Stroke Game 1 ep.1/2: Pediatric Case - SLICE Worldwide 2022
Shani Avnery Kalmanovich , Vincent COSTALAT , Wim van Zwam , Demetrius Lopes , Eitan Abergel , CHRISTOPHE COGNARD , Francisco José Mont' Alverne , Johanna Fifi
Stroke Game 1 ep.2/2: Pediatric Case - SLICE Worldwide 2022
Vincent COSTALAT , Demetrius Lopes , Tudor Jovin , Mayank Goyal , Raul Nogueira , Johanna Fifi
Stroke Game 2 ep.1/3: Minor stroke patients - SLICE Worldwide 2022
Vincent COSTALAT , Demetrius Lopes , Tudor Jovin , Mayank Goyal , Raul Nogueira , Johanna Fifi
Stroke Game 2 ep.3/3: Minor Stroke - SLICE Worldwide 2022
Vincent COSTALAT , Demetrius Lopes , Tudor Jovin , Mayank Goyal , Raul Nogueira , Johanna Fifi
Stroke Game 2 ep.2/3: How to face an ICAD? - SLICE Worldwide 2022
CHRISTOPHE COGNARD , Eitan Abergel , Federica Rizzo , Javier Lagos Servellon , Marc Ribo , Pasquale Mordasini , Shani Avnery Kalmanovich , Vincent COSTALAT
Stroke Game 3: Posterior circulation stroke - SLICE Worldwide 2021
Davi Haddad , Fenne Vandervorst , Shani Avnery Kalmanovich , Tommy Andersson , Vincent COSTALAT , Wim van Zwam
Stroke Game 4: Vertebral tandem occlusion - SLICE Worldwide 2021
Shani Avnery Kalmanovich , Vincent COSTALAT , Federico Cagnazzo , Wim van Zwam , Marc Ribo , Demetrius Lopes , Ameer Hassan , Franz Bozsak , Vedran Župančić , Hani Ridwan , Tommy Andersson , Tudor Jovin
Stroke Game 5: Failed Thrombectomy - SLICE Worldwide 2021
Greg Albers , Manuel Alberto Correia , Francisco José Mont' Alverne , Federico Cagnazzo , Mayank Goyal , Shani Avnery Kalmanovich , Danijel Trajkovic , Tudor Jovin , Vincent COSTALAT , Wim van Zwam
Stroke Game 6 - SLICE Worldwide 2021
Search
Video Related
- 4.5
No Speakers
Experience the Axium™ Effect : Axium™ Detachable Coil Family - SLICE TUTORIAL
- 5
No Speakers
Pipeline™ Vantage with Shield Technology™ for intracranial aneurysms - SLICE TUTORIAL
- 4.8
No Speakers
Pipeline™ Flex embolization device with Shield technology™
- 4
Paolo Machi , Shani Avnery Kalmanovich , Vincent COSTALAT
Recorded Case 2.1 : Tiantan Hospital, Beijing - SLICE Worldwide 2020
- -
Shani Avnery Kalmanovich , Vincent COSTALAT
Recorded Case 3.3 : Tiantan Hospital, Beijing - SLICE Worldwide 2020
- 5
Shani Avnery Kalmanovich , Vincent COSTALAT , Tommy Andersson , Marc Ribo , Pasquale Mordasini , Arkadiusz Kacała , Lina Palaiodimou , Demetrius Lopes
Stroke Game 1: Isolated Cervical Occlusion Management complicated of hemodynamic failure - SLICE Worldwide 2021
- -
Arkadiusz Kacała , CHRISTOPHE COGNARD , Federico Cagnazzo , Vincent COSTALAT
Best Technique 1: Cardioembolic carotid occlusion - SLICE Worldwide 2021
- -
CHRISTOPHE COGNARD , Eitan Abergel , Federica Rizzo , Javier Lagos Servellon , Marc Ribo , Pasquale Mordasini , Shani Avnery Kalmanovich , Vincent COSTALAT
Stroke Game 3: Posterior circulation stroke - SLICE Worldwide 2021
- 5
Marc Ribo
SYMPOSIUM MEDTRONIC: Distensibility and sudden recanalization - Dr Marc RIBO
- -
{{comment.user_first_name}} {{comment.user_last_name}}
{{comment.date_ago}}