J Korean Neurosurg Soc.  2024 Jul;67(4):477-482. 10.3340/jkns.2023.0158.

Real-Time Visualization of Thrombus during Suction Thrombectomy : Contrast-in-Stasis Technique

• Lee YS

• KMID: 2556745
• DOI: http://doi.org/10.3340/jkns.2023.0158

Abstract

This report introduces a simple method to visualize the captured thrombus in real-time during suction thrombectomy using “contrast-in-stasis technique”. It enables visualization of the thrombus captured by a suction catheter as it is being retrieved through the tortuous course of the carotid artery eventually into the guiding catheter. It also offers visual identification of important findings such as fragmentation of thrombus into pieces or loss of thrombus during retrieval, and, therefore, helps clinicians to make further critical decisions during the procedure.

Keyword

Contrast-in-stasis; Suction thrombectomy; Real-time; Thrombus

Figure

• 

  Fig. 1. Anterior-posterior (A) and lateral (B) views of carotid angiogram of a patient with the left internal carotid artery terminal occlusion show stagnation of contrast without an antegrade blood flow. Note that the occlusion point cannot be visualized by a subtraction angiography with guiding catheter injection.

• 

  Fig. 2. Anterior-posterior (A) and lateral (B) views of non-subtraction carotid angiogram show the exact occlusion point (white arrows) at the left internal carotid artery terminum. Contrast is injected continuously and gently via a suction catheter (black arrows) while it is being advanced.

• 

  Fig. 3. A 50 mL syringe is set up with its plunger fixed by a 20 mL syringe to generate a strong negative pressure.

• 

  Fig. 4. Serial images (A-C) of non-subtraction angiogram using “contrast-in-stasis technique” for a patient with the distal internal carotid artery occlusion show the captured thrombus (black arrowheads) in realtime as it is being retrieved through the tortuous course of the carotid artery into the guiding catheter.

• 

  Fig. 5. Serial images (A-C) of non-subtraction angiogram using “contrast-in-stasis technique” show that, when the suction catheter is retrieved without any thrombus captured, no thrombus is visualized on the tip of the suction catheter (white arrowheads) and, at the same time, the stagnated contrast rapidly disappears being aspirated by the suction catheter.

• 

  Fig. 6. Serial images (A-D) of non-subtraction angiogram using “contrast-in-stasis technique” for a case of the cervical internal carotid artery occlusion show that the whole block of thrombus in a complex shape (black arrowheads) is being retrieved stably into the guiding catheter. The photograph (E) shows the retrieved thrombus.

• 

  Fig. 7. Right carotid angiogram (A) of a patient with a typical middle cerebral artery infarction shows an occlusion of the middle cerebral artery. However, serial images (B-E) of non-subtraction angiogram using “contrast-in-stasis technique” show that an extremely long thrombus with huge burden (black arrowheads) is being retrieved stably into the guiding catheter. The photograph (F) shows the retrieved thrombus.

Reference

References

1. Park H. A suction thrombectomy technique: a rapid and effective method for intra-arterial thrombolysis. J Cerebrovasc Endovasc Neurosurg. 17:13–19. 2015.

2. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 50:e344–e418. 2019.

3. Roh HK, Ju MW, Byoun HS, Park B, Park KH, Lim J. Forced suction thrombectomy in patients with acute ischemic stroke using the SOFIA Plus device. J Cerebrovasc Endovasc Neurosurg. 24:241–248. 2022.

4. Suh CH, Lee YJ. Recent trend for endovascular treatment in patients with acute ischemic stroke: balloon guide catheter. Neurointervention. 14:142–143. 2019.