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mohd shafie abdullah – April 26, 2013
“I'm thinking of deploying telescoping approach of 2 Leos and jailing technique with loose packing...”
Pakrit Jittapiromsak – April 16, 2013
“Thank you for your comment. Honestly, in my experience, if the stent(s) is(are) placed and oppose...”
Steve Dechan – April 13, 2013
“Just a question please, there are reports of instent restenosis at the distal and proximal ends o...”
wael elshawaf – April 13, 2013
“Weal EL-shawaf ,MD. Thank you for all Pr Dr how start this decision and to learn more and more ,s...”
Willem Jan van Rooij – April 5, 2013
“I am surprised by the comment of Laurent Spelle. The only thing we can learn from a case like thi...”
Rescue forced-suction thrombectomy using the reperfusion catheter of the penumbra system for thromboembolism during coil embolization of ruptured cerebral aneurysms.
- Authors: Kang Dong-Hun, Kim, Yong-Sun, Park Jaechan, Hwang Yang-Ha
- Reference: Neurosurgery. 2012 Mar;70 Suppl Operative
- Published: March 2012
- Link: Access the abstract here
The authors showed how they coped with thromboembolic complications during the intracranial aneurysm coiling procedure after failed response to medical thrombolysis.
A simple mechanical thrombectomy by using a modification of the Penumbra System was described. Instead of using a typical combination of the separator wire and negative-pressure suction machine, the authors used only a reperfusion catheter and manually created negative pressure within a 20- or 50-cc syringe by pulling the plunger forcefully.The authors also discussed about potential limitations of this procedure.
Rates of thromboembolism in intracranial aneurysm coiling procedure range from 5.9 to 10.4%. Silent infarction is even higher about 60%. Thromboembolic events can be expected during intracranial aneurysm coiling. They can be reduced by a good treatment strategy. A careful preoperative planning is very important especially when treating wide-necked or large aneurysms. In case of using a stent-assisted coiling technique antiplatelet resistant should be anticipated.During the procedure systemic administration of heparin, aspirin,clopidogrel, or glycoprotein IIb-IIIa antagonists is increasingly used to reduce the risk of thromboembolism.
Currently, intraoperative recue therapy in thromboembolic events complicating intracranial aneurysm coiling has been reported using intra-venous and/or intra-arterial abciximab, tirofiban. After refractory to medical thrombolysis, mechanical assistance with the use of a microwire and microcatheters can also be tried. Grade III of the Thrombolysis In Myocardial Infarction or complete recanalization after the rescue procedure ranges from 14.3 to 92%. In this article the authors still get a good recanalization rate after refractory totirofiban injection.