Presentations of medical case resolutions in the form of a “serious game”. They are carried out live through challenges between teams of doctors on high-fidelity silicone models designed from the anatomy of real patients.
Isolated Cervical Occlusion Management complicated of hemodynamic failure
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.
Presentation of case resolution in the form of a “serious game”.
Isolated symptomatic cervical occlusion with underlying double stenosis – in cervical and clinoid portion of ICA treated with thrombectomy and full carotid stent reconstruction. Video includes:
Isolated symptomatic cervical occlusion – data and main concerns
Conservative vs. interventional treatment – decision making process:
In favor of interventional treatment:
Stroke incidence after TIA – in publications:
Minor stroke (NIHHS 8) due to isolate acute cervical ICA occlusion – in publications:
Conservative management of minor strokes due to isolated acute cervical ICA occlusion – in publications:
MRI : easily helps to differentiate embolic vs. hemodynamic nature of a stroke (DWI - watershed infarcts, PWI – hypoperfusion)
Isolated symptomatic cervical occlusion – thrombectomy technique:
Precision is crucial – main goal – to restore the flow and to avoid distal embolization!
1/ Necessity to investigate whether it is only a clot or a clot with underlying disease :
- option 1: trap the clot with aspiration catheter proximally and SR distally, with double aspiration on BCG and aspiration catheter while retrieving (disadvantage: you can injure the plaque in ICA origin when retrieving SR, you will have to re-cross the lesion once again)
- option 2: place distal protection device (Spider, Emboshield ect.) and perform thromboaspiration under double – proximal and distal protection
- option 3: do a simple aspiration by large bore intermediate catheter (on BCG inflation)
In case of difficulties when passing by ICA origin:
TIPS and TRICKS:
Underlying upper/long ICA lesions:
If there is a need to reconstruct the artery: multiple stents bridging
- 2 approaches: from proximal to distal/ or from distal to proximal
- in the upper parts of ICA (f.ex siphon) it is possible to use:
- it is important to cover all the portions of ICA and to do the overlap with stents of at least 1 cm
- at the end you can perfom post-PTA if needed
Be aware of higher risk of hemorrhage in the patients with established infarcts (due to hemorrhagic transformation) or with hypoperfusion (due to reperfusion injury).
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