J Korean Neurosurg Soc.  2012 Feb;51(2):75-80. 10.3340/jkns.2012.51.2.75.

Intra-Arterial Thrombolysis Using Double Devices: Mechanicomechanical or Chemicomechanical Techniques

• Park H
• Hwang GJ
• Jin SC
• Bang JS
• Oh CW
• Kwon OK

• KMID: 1441413
• DOI: http://doi.org/10.3340/jkns.2012.51.2.75

Abstract

OBJECTIVE
To optimize the recanalization of acute cerebral stroke that were not effectively resolved by conventional intraarterial thrombolysis (IAT), we designed a double device technique to allow for rapid and effective reopening. In this article, we describe the feasibility and efficacy of this technique.
METHODS
From January 2008 to September 2009, twenty patients with acute cerebral arterial occlusion (middle cerebral artery : n=12; internal carotid artery terminus : n=5; basilar artery : n=3) were treated by the double device technique. This technique was applied when conventional thrombolytic methods using drug, microwires, microcatheters and balloons did not result in recanalization. In the double device technique, two devices are simultaneously placed at the lesion (for example, one microcatheter and one balloon or two microcatheters). Chemicomechanical or mechanicomechanical thrombolysis was performed simultaneously using various combinations of two devices. Recanalization rates, procedural time, complications, and clinical outcomes were analyzed.
RESULTS
The initial median National Institute of Health Stroke Scale (NIHSS) was 16 (range 5-26). The double device technique was applied after conventional IAT methods failed. Recanalization was achieved in 18 patients (90%). Among them, 55% (11 cases) were complete (thrombolysis in cerebral infarction 2B, 3). The median thrombolytic procedural time including the conventional technique was 135+/-83.7 minutes (range 75-427). Major symptomatic hemorrhages (neurological deterioration > or =4 points in NIHSS) developed in two patients (10%). Good long term outcomes (modified Rankin Scale < or =2 at 90 days) occurred in 25% (n=5) of the cases. Mortality within 90 days developed in two cases (10%).
CONCLUSION
The double device technique is a feasible and effective technical option for large vessel occlusion refractory to conventional thrombolysis.

Keyword

Acute; Stroke; Thrombolysis; Double devices

MeSH Terms

Basilar Artery
Carotid Artery, Internal
Cerebral Arteries
Cerebral Infarction
Glycosaminoglycans
Hemorrhage
Humans
Stroke
Glycosaminoglycans

Figure

• 

  Fig. 1 We performed a double device technique for efficient thrombolysis with a combination of various devices such as the following : combination wire (arrowhead) with catheter (white arrow) (A), coil (arrowhead) with catheter (white arrow) (B), balloon (arrowhead) with catheter (white arrow) (C), coil (arrowhead) with balloon (white arrow) (D), and coil (arrowhead) with wire (white arrow) through stent (triangle) (E). In addition, we used two devices at different occlusion sites for simultaneous thrombolysis with the following : microcatheter and microcatheter (F) and microwire and microwire (G).

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  Fig. 2 A : Selective angiogram showing occlusion at BT and bilateral PCAs. B : Angiogram obtained during thrombolysis with the double device technique (arrowhead : wire, white arrow : microcatheter) showing occlusion at the proximal portion of the right PCA and left PCA. C : Two microcatheters (white arrow) were placed at proximal portions of different PCAs. D : Thrombolysis was performed by the double device technique with coils at bilateral PCAs. E : Final angiogram showing complete recanalization. BT : basilar tip, PCAs : posterior cerebral arteries.

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