Mechanical Thrombectomy of Acutely Occluded Flow-Diverters - Neuroendovascular Surgical Technique Demonstration: 2-Dimensional Operative Video.

Journal Article (Journal Article)

Flow-diversion with pipeline embolization devices (PED, Medtronic, Dublin, Ireland) is widely used for embolization of complex intracranial aneurysms.1 In-stent thrombosis can be a dreadful complication after PED deployment. Intra-arterial glycoprotein IIb-IIIa inhibitors and intravenous tissue plasminogen activator have been used in an attempt to achieve recanalization.2 However, large clots may not be effectively dissolved by pharmacological agents, thus requiring mechanical thrombectomy (MT).3 Our group recently published the first technical report on successful MT of acutely occluded PEDs in 2 patients.4 Here, we showcase the successful MT of a patient who sustained acute in-stent PED thrombosis. Informed written consent was obtained. In this case, we combined stentriever and contact aspiration thrombectomy techniques. We highlight important pitfalls and tips to prevent PED displacement, removal or vessel injury during endovascular manipulation. The most important consideration is to deploy the distal end of the stentriever inside the PED but also as distally as possible. Thus, correct apposition and alignment of the distal markers of both devices is performed under "native" unsubstracted fluoroscopic view (for better PED visualization) before MT. In this surgical video we describe the technique in detail.

Full Text

Duke Authors

Cited Authors

  • Roa, JA; Hasan, DM; Samaniego, EA

Published Date

  • August 1, 2020

Published In

Volume / Issue

  • 19 / 2

Start / End Page

  • E176 - E177

PubMed ID

  • 31768547

Electronic International Standard Serial Number (EISSN)

  • 2332-4260

Digital Object Identifier (DOI)

  • 10.1093/ons/opz345

Language

  • eng

Conference Location

  • United States