leipzig interventional course leipzig januar 30 ......exchange to neuromax (6f 0.88” 105 or 125...
TRANSCRIPT
![Page 1: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/1.jpg)
Bernhard Reimers, MD
Humanitas University, Rozzano-Milan, Italy
Periprocedural neurologic complications: How to manage?
7 min
LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30th 2018
![Page 2: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/2.jpg)
Neurologic complications during CAS: What to do?
- Neurologic evaluation of kind (coma, side ecc.) and severity (NIHSS) of symptoms.
- Try to find cause of symptoms (vessel occlusion, embolization, hypotension, hemorrhage).
- Have a close look to the carotid angiography and perform intracranial angiography.
- Control blood pressure, ACT, ECG, etc.- If angio normal complete procedure and perform
directly CT scan.
![Page 3: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/3.jpg)
Be humble!
![Page 4: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/4.jpg)
Call Neurologist!
![Page 5: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/5.jpg)
Call local stroke team or neuroradiologist!
![Page 6: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/6.jpg)
Causes of neurologic complications during CAS:
- Vessel occlusion- Embolization- Hemorrhage- Hyperperfusion
![Page 7: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/7.jpg)
Causes of neurologic complications during CAS:
- Vessel occlusion: dissection, thrombosis- Embolization- Hemorrhage- Hyperperfusion
![Page 8: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/8.jpg)
Dissections
Linear
Spiral
RCCALCCA
LCCA
CCA ICA
![Page 9: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/9.jpg)
Stent & restore flow
Treatment of iatrogenic dissection of the LCCA with stenting
![Page 10: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/10.jpg)
Filter occlusion
Filter full of debris
- Aspirate (using a catheter) before filter removal
![Page 11: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/11.jpg)
Steiner-Boeker; AJNR
Acute stent Thrombosis
1. Aspiration
2. Intra-arterial rtPA
3. Surgical removal
Prevention: Prepare patientswith double antiplatelet
treatment
![Page 12: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/12.jpg)
Acute stent Thrombosis
Courtesy C. Setacci
![Page 13: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/13.jpg)
Neurologic complications during CAS:
- Vessel occlusion- Embolization- Hemorrhage- Hyperperfusion
![Page 14: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/14.jpg)
Plaque prolapse, fibrous cap rupture
or cheese grater effect
To prevent embolization from plaque prolaps:- Have a close look at final angio. If you detect prolaps evaluate
second stent- Use mesh stents
![Page 15: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/15.jpg)
Large Vessel Embolization M1/M2
ICAECA
CCA
![Page 16: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/16.jpg)
Occlusion of left, middle cerebral artery,
TIME to needle: 0 minutes
Cardioembolic Stroke
Following reopening
![Page 17: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/17.jpg)
Build the tower of power
Long sheath. Evaluate
advancement into ICC
through stent; evaluate
exchange to NeuroMax
(6F 0.88” 105 or 125 cm)
without loosing wire.
![Page 18: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/18.jpg)
‘Tower of Power’
Long sheath
Aspiration catheter
(5 Max ACE 0.68-64”).
![Page 19: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/19.jpg)
‘Tower of Power’
Long sheath
Aspiration catheter
Micro catheter
(150-160cm 2.95-2.6 F) to
support wires and allow
contrast check or use
retrieval devices.
![Page 20: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/20.jpg)
‘Tower of Power’
Long sheath
(Neuron Max 6F 0.88”
105 or 125 cm)
Reperfusion catheter
(5 Max ACE 0.68-64”)
Micro catheter
0.014” neuro - wire
To cross occlusion and
seek distal vessel.
![Page 21: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/21.jpg)
Neuron MAX 088 long sheath,
5MAX ACE 64 reperfusion catheter,
Velocity microcatheter
Transend EX 0.014 guidewire
After thrombus aspiraton
Endovascular treatment
![Page 22: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/22.jpg)
Neurologic complications during CAS:
- Vessel occlusion- Embolization- Hemorrhage- Hyperperfusion
![Page 23: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/23.jpg)
Intracranial Hemorrhage
Vessel perforation from distal wire.Reverse heparin. Control BP. Perform CT
![Page 24: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/24.jpg)
Neurologic complications during CAS:
- Vessel occlusion- Embolization- Hemorrhage- Hyperperfusion
![Page 25: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/25.jpg)
Hyperpefusion Syndrome
Clinical symptoms: confusion, headache, seizures
•Elderly
• Blood pressure control
•History of stroke
•Severe hemodynamically significant stenosis
•Severe stenosis with contralateral occlusion
•String-sign
Predictors:
![Page 26: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/26.jpg)
Hyperpefusion Syndrome
Clinical symptoms: confusion, headache, seizures
•Low BP control !!!!!
•ACT<200sec after procdure
•Corticosteroids
•Antiepileptic drugs
•Surgery (Haematoma)
Treatment
Cerebral edema and hemorrhage
![Page 27: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/27.jpg)
Conclusions- complications occur …. and during CAS the end-organ is the head !!!
- analyze origin, site & severity
- try to manage without overdoing (you may worsen situation)
- Call all peoples of the hospital involved in stroke
![Page 28: LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30 ......exchange to NeuroMax (6F 0.88” 105 or 125 cm) without loosing wire. ‘Tower of Power’ Long sheath Aspiration catheter (5](https://reader035.vdocuments.site/reader035/viewer/2022081620/61186c1c0dc3ca502e7bf784/html5/thumbnails/28.jpg)
Bernhard Reimers, MD
Humanitas University, Rozzano-Milan, Italy
Periprocedural neurologic complications: How to manage?
7 min
LEIPZIG INTERVENTIONAL COURSE Leipzig Januar 30th 2018