BackTable / VI / Podcast / Episode #178
Challenging Stroke Thrombectomies with Tough Clot
with Dr. Matt Gounis and Dr. Hannes Nordmeyer
Interventional Neuroradiologist Dr. Hannes Nordmeyer and Biomedical Engineer Dr. Matt Gounis discuss compositions of tough clots, approaches to stroke thrombectomy, and bailout stenting.
BackTable, LLC (Producer). (2022, January 10). Ep. 178 – Challenging Stroke Thrombectomies with Tough Clot [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Matt Gounis
Dr. Matt Gounis is a biomedical engineering professor at the University of Massachusetts Medical School.
Dr. Hannes Nordmeyer
Dr. Hannes Nordmeyer is an interventional neuroradiologist in Germany.
Dr. Michael Barraza
Dr. Michael Barraza is a practicing interventional radiologist (and all around great guy) with Radiology Associates in Baton Rouge, LA.
In this episode, interventional neuroradiologist Dr. Hannes Nordmeyer, biomedical engineering professor Dr. Matt Gounis, and our host Dr. Michael Barraza discuss compositions of tough clots, approaches for stroke thrombectomy, and bailout stenting.
Dr. Nordmeyer believes that interventionalists are still struggling to find the most effective method for pulling clots. He says that the use of double stent retrievers has shown high success rates, but it would be ideal to have one retriever that can work on its own. He describes his equipment setup for a standard large vessel occlusion. Dr. Nordmeyer notes clot location and behavior within the first two passes determines whether or not the operator should continue with the stent retrieval approach or change the approach.
Dr. Gounis evaluates various devices by defining “success” as achievement of TICI 3 with the first pass. He comments on the current development of very large bore aspiration catheters, such as the 088 Millipede catheter and the Tenzing catheter. He also emphasizes that the success of the procedure relies largely on the composition of the embolus. Fibrin-rich clots are less likely to integrate with the stent retriever. We discuss Dr. Nordmeyer’s technique, which utilizes a microcatheter and the NIMBUS device to pin and retrieve the challenging clot.
We also cover bailout stenting and the benefits of recanalization when clot removal is not possible.
SWIFT DIRECT Trial:
Preclinical Evaluation of Millipede 088 Intracranial Aspiration Catheter:
The Novel Tenzing 7 Delivery Catheter Designed to Deliver Intermediate Catheters to the Face of Embolus Without Crossing:
Factors Influencing Recanalization After Mechanical Thrombectomy With First-Pass Effect for Acute Ischemic Stroke:
NIMBUS Geometric Clot Extractor:
[Dr. Michael Barraza]:
One of the things that I struggle with is knowing when to stop when you've made several passes, in particular, where I struggle is where I see just a little bit of improvement with each pass, just enough to keep going, but never open up the vessel entirely. Or when you've opened it up, and then it just shuts down immediately. Now, Dr. Nordmeyer, what is your end point in these cases where you have trouble opening these up?
[Dr. Hannes Nordmeyer]:
I can tell when to stop. It depends so much on the whole setting. So if it's a young person and the time window is good, and there were no early infarct signs at the beginning of the procedure, it's very hard to stop and say, so now this patient is going to have a huge MCA infarct. So, I almost never stop before getting a reasonable recanalization, even if it's stenting and angioplasty at the end.
[Dr. Matthew Gounis]:
And just to add to that, I think, there's a lot of advancements in imaging in the angio suite, both Siemens and Philips now have these CT trajectories that are saddled trajectories. And, what that gives you is much better. It's almost like looking at a multi detector CT. So I'm curious in the future, and it just has to be studied, but that if rather than having a time metric as when to stop, have that informed by a non-con and CTA. That might be an option.
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