Michael Abraham, MD, FAHA, of the University of Kansas Hospital presents “Catheters, Coils, and Clots”.
Neurointerventional Surgery
- What is it about?
- Treatment options for those who have experienced an aneurysm.
- Types of therapies for those who have experienced different types of strokes.
- Endovascular Therapy
- Endovascular therapy “inside the blood vessel”
- This therapy involves placing catheters in the brain
- Angioplasty Machine
- A machine that activates and monitors catheters that go into the brain.
- 2 D picture of what is going on in the brain.
- Types of Strokes
- Blockage: 85% ischemic
- An ischemic stroke happens when a blockage cuts off the blood supply to part of your brain, killing brain cells.
- Bleeding: 15% hemorrhagic stroke
- A hemorrhagic stroke is a life-threatening medical condition that happens when a blood vessel in your brain ruptures and bleeds.
Time matters for a hemorrhagic stroke.
Ischemic Strokes
- What is it?
- An ischemic stroke happens when a blockage cuts off the blood supply to part of your brain, killing brain cells.
- Ischemic strokes
- Every minute of blockage causes 2 million brain cells to die.
- Every minute of save treatment time means an average of 4.2 days of extra healthy life.
- Every 20 minutes decrease in treatment time means a gain of average equivalent of 3 months of a disability free life.
Ischemic Stroke Treatments
Treatments for Ischemic Stroke
- The main treatment for an ischemic stroke is a medicine called tissue plasminogen activator (tPA).
- It breaks up the blood clots that block blood flow to your brain. A doctor will inject tPA into a vein in your arm.
- This type of medicine must be given within 3 hours after your symptoms start.
IV Treatment
- The most effective medical treatment for acute ischemic stroke (AIS) is to offer intravenous thrombolysis during the ultra-early period of time after the onset.
Endovascular Thrombectomy
- Treatment where the blood clot is either removed using a mechanical device (most often stent retrievers or thrombolytic medication) where it is injected directly to the blood clot.
Merci Clot Retriever is a biomedical device used to treat strokes.
- It is an endovascular device for removal of acute intracranial thrombus.
- It looks like a cork-screw device which is then inserted through the femoral artery in the groin and travels to the site of the blood clot in the brain.
- The tool grabs the clot and pulls it out through the artery.
More advanced treatments for strokes.
- Aspiration thrombectomy-place catheter in the brain to suck out the blood clot 2008
- Stent retriever: spans into the clot and integrates with the clot for 4 to 5 min and then slowly pull it out
- About 10 around the world
- Balloon syringe: offer a multi-faceted approach for clot retrieval by creating proximal flow arrest, reducing embolic burden, and shortening procedure time.
- Endoplasty net and catches any debris surrounding the area.
- Stent Retriever:
- Spans into the clot and integrates with the clot for 4 to 5 min and then slowly pull it out.
- It is a cylindrical device that consists of a self-expanding stent mounted on a wire and deployed within a catheter.
- Once at the site of the blood clot, the stent is released from within the catheter and self-expands within the thrombus.
- Types of Catheters
- 10 different types you can find around the world.
- All very similar with minor differences.
After the Stroke
- Rehab
- Physical therapy
- Occupational therapy
- Speech therapy
- Exercising
- Social life
- Depression symptoms
- Stroke outreach groups
Hemorrhagic Stroke
Hemorrhagic stroke
- Caused by a weakened vessel that ruptures and bleeds into the surrounding brain.
Subarachnoid Hemorrhage
- Severe headache, nausea, vomiting, loss of conscious
- Ruptured aneurysm or trauma
- Brain aneurysm: treat within 12-18 hours
- 30-40% of patients die before reaching the hospital
- Treatment: coil embolization and clipping
- Coil embolization: a procedure used to treat an aneurysm.
- This is accomplished by placing a small and soft metal coil inside the aneurysm.
- This serves to block blood flow and prevent rupture of the aneurysm.
- Clipping: a type of microsurgery in which a metal surgical clip is used to close off an aneurysm in the brain.
- Coil embolization: a procedure used to treat an aneurysm.
- Ruptured aneurysm or trauma
Treatment Options for Hemorrhagic strokes:
- Neurosurgical clipping
- Endovascular coiling, stent/balloon-assisted coiling, or flow diversion
- Coiling: take coils and put it into the aneurysm/ aneurysm is in the clot
- Stent: helps keep coils in clot
- Balloon: helps keep coils in clot
- Flow diverter stent: Large 12 ml stent or bigger
- WEB (woven endovascular bridge):
- Looks like a sphere or cubicle configuration which is a single layer that blocks the blood from going into aneurysm.
- Vary in size and do the same thing as coils.