Catheters, Coils, and Clots — Oh My!

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. 

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.