Carotid cutdown for mechanical thrombectomy in the setting of intravenous tissue plasminogen activator: A technical report.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
Ritam GhoshPascal M Jabbour

Abstract

Acute ischemic stroke (AIS) is a leading cause of mortality and morbidity in the world. Patients are usually treated with endovascular methods and access is often gained trans-femoral or trans-radial. In patients with difficult anatomy, in rare cases the approach must be done trans-cervical. Our case illustrates a patient who received IVTPA prior to attempted endovascular treatment, leading to a direct carotid cutdown for mechanical thrombectomy. Our patient presented with a left M1 occlusion and had received intravenous thrombolytic at the presentation of his symptoms. Due to unfavorable anatomy and tortuous aortic arch, conventional access could not be obtained. In order to achieve reperfusion while maintaining hemostasis, a decision was made to perform an open carotid cutdown to catherize the left internal carotid artery to successfully retrieve the thrombus. This resulted in a TICI2B revascularization. This is the first reported case of direct carotid access in the setting of acute ischemic stroke with IVTPA. Open technique allowed us to maintain hemostasis while bypassing the tortuous arch and achieving reperfusion and give the patient the best chance for a functional recovery.

References

Jun 20, 2013·JAMA : the Journal of the American Medical Association·Jeffrey L SaverLee H Schwamm
Nov 10, 2013·Journal of Neurointerventional Surgery·Ashutosh P JadhavBrian T Jankowitz
Jun 17, 2015·Journal of Neurointerventional Surgery·Martin WiesmannOmid Nikoubashman
Oct 8, 2015·The Neuroradiology Journal·Carlos CastañoMihaela Ciorba
May 2, 2016·Clinical Neurology and Neurosurgery·Badih DaouPascal Jabbour
Jun 25, 2018·Journal of Vascular and Interventional Radiology : JVIR·Lars Fjetland, Sumit Roy
Jul 18, 2019·Stroke; a Journal of Cerebral Circulation·Omaditya KhannaPascal M Jabbour

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