Masterclass #12: Carotid T thrombectomies: A competitive field between stentriever and aspiration?

Vincent COSTALAT, Urs FISCHER, Vitor MENDES PEREIRA, Jacques MORET, Laurent SPELLE

After large-vessel ischemic strokes, it’s been seen that 90-day results of endovascular thrombectomies were worse after treating carotid-T occlusions than M1 occlusions. What makes carotid-T occlusions so challenging?

Join Professors Jacques Moret and Laurent Spelle along with their expert panel as they explore the key elements involved, including…

The challenge of collateral circulation in carotid-T occlusions:

• These occlusions might have little or no anterior circulation – if the collateral flow is compromised, what is the outcome?
• Speed and technique are critical in removing clots in these situations, but should we use a medical approach first?  What evidence do we have to make our decision?

High clot volume – the clot burden of carotid-T occlusions: 

• What is the importance of clot mass?
• Does clot size equally impact the efficacy of mechanical thrombectomy and thrombolytics?
• Which type of occlusions would lytics be most effective in? Is thrombolysis more effective if the occlusion is distal?
• Can clot size affect the number of passes necessary for MT?

Mechanical thrombectomy techniques used in managing carotid-T occlusions – from stentriever or aspiration alone, or both in the “full” or “BADDASS” technique.

• Learn why the treatment of carotid-T occlusions, with their greater clot load and larger vessel diameter, are perfectly suited for any of these MT strategies.
• Discover ongoing trials such as SWIFT DIRECT and what current studies and trials say about the preferred MT strategy to employ.

Specially chosen cases further illustrate:

• The dangers involved in embolization.
• Which type of anesthesia or conscious sedation should be preferred in treating carotid-T occlusions and whether patient age could play a role in which one to use.
• Issues involved in thrombolysis – could it useful before or after MT? Does bridging thrombolysis necessarily prevent using lytics after an intervention?
• What impact has the COVID pandemic had on the management of these patients?