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1
Samaniego, Edgar A., and David Hasan, eds. Acute Stroke Management in the Era of Thrombectomy. Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-17535-1.
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Kahn, S. Lowell. Distal Occlusion Thrombectomy Technique. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0022.
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The distal occlusion balloon thrombectomy technique involves placement of an occlusion balloon immediately distal to the thrombus or embolus. The balloon overlaps the antegrade wire. With the balloon inflated, the thrombotic/embolic material is removed over the antegrade wire using the desired thrombectomy catheter or device. The inflated balloon prevents distal migration of the embolic material during removal. Intermittent digital subtraction angiography is performed to assess for residual debris. When sufficiently extracted, the balloon is deflated and removed. Most commonly, this is performed with the balloon inserted in a retrograde manner. However, if distal access is not feasible, the antegrade sheath can be upsized.
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Abramowicz, A. Elisabeth. Endovascular Thrombectomy in Acute Ischemic Stroke. Edited by David E. Traul and Irene P. Osborn. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190850036.003.0009.
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Endovascular thrombectomy (EVT) for acute ischemic stroke is a new and powerful treatment modality that restores functional independence to many victims. Although it has been proved of value in large-vessel occlusion of the anterior circulation, it is also used in basilar artery embolism. Time to successful reperfusion is a major determinant of recovery. A subset of patients has robust collaterals and will benefit from treatment up to 24 hours after stroke onset; the presence of salvageable brain tissue (penumbra) must be ascertained by specialized imaging. The number of patients who can benefit from EVT is estimated at 100,000/year in the United States alone in more than 300 designated Thrombectomy-Capable Stroke Centers. EVT is a new anesthetic emergency. Anesthesiologists must be actively involved in creating protocol-driven care for acute ischemic stroke patients.
4
Nam, Hyo Suk, and Byung Moon Kim, eds. Thrombolysis and Thrombectomy in Acute Ischemic Stroke. MDPI, 2023. http://dx.doi.org/10.3390/books978-3-0365-7599-5.
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Samaniego, Edgar A., and David Hasan. Acute Stroke Management in the Era of Thrombectomy. Springer, 2019.
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6
Cowling, Mark G., and L. Baert. Vascular Interventional Radiology: Angioplasty, Stenting, Thrombolysis and Thrombectomy. Springer London, Limited, 2006.
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7
Samaniego, Edgar A., and David Hasan. Acute Stroke Management in the Era of Thrombectomy. Springer International Publishing AG, 2020.
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8
Kahn, S. Lowell. Directional AngioJet Thrombectomy with Guide Catheter Helical Spin Technique. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0037.
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The presence of thrombus in the central veins is associated with a higher risk of development post-thrombotic syndrome. The AngioJet Solent Proxi (90 cm) and Omni (120 cm) catheters are commonly used peripheral thrombectomy devices indicated for acute arterial and venous thrombus removal. Both catheters are 6 Fr sheath/8 Fr guide catheter compatible, and both offer the Power Pulse feature, allowing the direct infusion of tissue plasminogen activator into the thrombus. The catheters are indicated for use in vessels greater than 3 mm, with an optimal vessel range between 6 and 20 mm. Their use in the removal of iliac vein and inferior vena cava thrombus is frequent. Although the system is purported to provide effective thrombectomy capabilities in larger vessels, incomplete thrombus removal is common with larger vessels. This chapter proposes a simple modification in the standard use of the AngioJet Solent Proxi and Omni catheters.
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Thrombectomy - Recent Advances in Ischaemic Damage Treatment [Working Title]. IntechOpen, 2021. http://dx.doi.org/10.5772/intechopen.94682.
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Irani, Zubin, and Sara Zhao. Dual and Balloon-Assisted AngioJet Thrombectomy for Iliofemoral Deep Venous Thrombosis. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0038.
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Lower extremity deep venous thrombosis (DVT) may be complicated by pulmonary embolism, post-thrombotic syndrome, and phlegmasia cerulea dolens. Due to these complications, the American Venous Forum now recommends thrombus removal for large or symptomatic thrombus burden. The AngioJet Solent Proxy and Omni thrombectomy sets are indicated for use in iliofemoral and lower extremity veins with a diameter ≥3 mm. The device has quickly become a preferred device among the available mechanical thrombectomy options. The AngioJet system has been demonstrated as both efficacious and safe as a method of thrombectomy in lower extremity DVT. This chapter discusses two techniques to utilize the AngioJet device in iliofemoral DVT.
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(Foreword), L. Baert, and Mark G. Cowling (Editor), eds. Vascular Interventional Radiology: Angioplasty, Stenting, Thrombolysis and Thrombectomy (Medical Radiology / Diagnostic Imaging). Springer, 2006.
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12
Saphenous Vein Graft Lesions and Thrombectomy for Acute Myocardial Infarction, An Issue of Interventional Cardiology Clinics. Elsevier, 2013.
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13
Markus, Hugh, Anthony Pereira, and Geoffrey Cloud. Acute stroke treatment. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198737889.003.0009.
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In this chapter the use of thrombolysis and the more recent application of thrombectomy in acute ischaemic stroke are covered. Organized stroke unit care has a major impact on both reducing mortality and improving outcome, and the chapter describes the evidence for this. It also covers other components of supportive acute stroke care, including the importance of instituting measures to avoid complications and to prevent early recurrent stroke.
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Chong, Ji Y., and Michael P. Lerario. Large Vessel Occlusion. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190495541.003.0002.
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Select patients who are not eligible for IV tPA, or who do not recanalize with IV thrombolysis alone, may be treated with acute endovascular therapies within a 6-hour window. Mechanical thrombectomy, with or without intra-arterial tPA, has recently been shown to be effective in treating acute ischemic stroke caused by large vessel occlusion. Intra-arterial therapy using approved stent retrievers has become the standard of care for acute large vessel occlusion.
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Steinberg, Alexis, and Bradley J. Molyneaux. Acute Stroke (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0019.
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The development of a stroke is an acute neurologic emergency that requires rapid evaluation as any delay in treatment worsens outcome. There are two main types of strokes, hemorrhagic and ischemic, each requiring specific rapid assessment and interventions. If an acute ischemic stroke is suspected, then a decision regarding thrombolytic therapy and endovascular thrombectomy has to be made quickly. A hemorrhagic stroke demands rapid medical management of blood pressure, reversal of coagulopathy, and early neurosurgical consult for possible external ventricular drain (EVD) placement and hemorrhage evacuation. This chapter expands on the indicated work-up in a suspected stroke patient in the setting of the rapid response team (RRT) calls, different imaging modalities, management options in the acute and subacute periods, and post-stroke complications.
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Stevens, David C., and Sabah Butty. Tips and Tricks of the AngioVac Device. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0039.
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The AngioVac system, which consists of a coil-reinforced large-bore cannula, bypass circuit, bubble trap/filter, and reinfusion cannula, allows percutaneous removal of unwanted vascular debris, such as venous thrombus or cardiac vegetations, during veno-veno bypass. External suction is applied via a centrifugal bypass pump and debris is funneled into the cannula and trapped in the bubble trap/filter. The blood is then returned through an 18 Fr venous reinfusion cannula. The use of the device in the iliocaval venous segments and right heart is effective and safe. Due to the challenging anatomy, pulmonary artery thrombectomy carries an increased risk of complication and should be undertaken with great care. The AngioVac system is a versatile tool for removing thrombus and other unwanted debris from the central venous system and the right heart.
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Preddie, Dean C., and Gregg A. Miller. The Rapid Fistula Declot. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0049.
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The rapid fistula declot is an endovascular approach to efficiently salvage the acutely thrombosed dialysis arteriovenous fistula (AVF). Thrombectomy of the AVF has historically been performed in the inpatient setting, but the advent of the outpatient vascular access center has vastly improved the efficiency and cost-effectiveness of dialysis access management. Fistula surveillance has generally been accepted to improve the life span of the AVF; however, due to the contribution of multiple factors, including uremia-induced vascular dysfunction, acute access thrombosis remains an issue. The rapid fistula declot is encapsulated in a simple algorithm of (1) clot removal, (2) repair of culprit stenoses, and (3) flow restoration. The preferred approach to each step is discretionary as long as near-complete evacuation of the fistula and venous outflow pathways of thrombus precedes flow restoration.
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Peppelenbosch, A. G., and Martijn Poeze. Ischaemic bowel in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0186.
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Intestinal ischaemia is caused by occlusion of the visceral arteries, thrombosis of the mesenteric veins, or by (low-flow) non-occlusive mesenteric ischaemia (NOMI). Each condition has a specific diagnostic and therapeutic work-up and prognostic significance. The incidence of acute mesenteric infarction is as low as 0.63 cases/100,000 person years, but overall mortality rates remains high at 74%. In general, a high index of suspicion is necessary and should be followed by administering therapeutic low molecular weight heparin or systemic heparin infusion. In these patients resuscitation and organ support are essential, but should not delay diagnostic work-up, including CT-angiography. With arterial occlusion, revascularization should be performed if indicated, preferentially using endovascular techniques prior to laparotomy. For venous occlusion, thrombolytic therapy directly into the superior mesenteric artery or venous thrombectomy can be performed, followed by laparotomy. The treatment of NOMI is to treat the underlying cause.
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Gattringer, Thomas, Christian Enzinger, Stefan Ropele, and Franz Fazekas. Vascular imaging (CTA/MRA). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198722366.003.0008.
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Non-invasive computed tomography angiography (CTA) and magnetic resonance angiography (MRA) constitute an integral part of the diagnostic workup of stroke patients, which—among the various techniques to image the complex cerebrovascular tree—can be conceptually placed between duplex sonography and digital subtraction angiography. CTA and especially MRA can be performed with different techniques and protocols that need to be used according to the clinical questions. In the setting of acute ischaemic stroke with the therapeutic option of endovascular thrombectomy, the rapid and reliable detection of large vessel occlusion has become of paramount importance. Both CTA and MRA can accomplish this and there is no need for contrast material when performing intracranial MRA. Vascular imaging is also essential to identify vessel-related causes of stroke such as large artery atherosclerosis, dissection, and some forms of arteritis mandating specific management or therapeutic intervention to avoid recurrence. Considering these aspects, frequent and targeted use of CTA or MRA is highly encouraged and especially relevant in young patients with stroke.
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Markus, Hugh, Anthony Pereira, and Geoffrey Cloud. Stroke Medicine (Oxford Specialist Handbooks in Neurology). Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198737889.001.0001.
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Recent years have seen a revolution in the profile of stroke. Often thought of as an untreatable disease we now realize that not only can many strokes be prevented, but acute treatment can have a major impact on outcome. There has been great recent interest in thrombolysis and thrombectomy but other aspects of stroke care including organized stroke unit care, and effective secondary prevention and rehabilitation also have a major impact on outcome. Clinicians looking after stroke patients need rapid access to up-to-date practical information on how to look after stroke patients. This handbook of Stroke Medicine is aimed to provide a ready source of information for both stroke trainees and consultants. It covers diagnosis and investigation of the stroke patient, as well as treatment ranging from primary and secondary prevention, to acute care and rehabilitation. It also covers rarer causes of stroke and the increasing important area of vascular cognitive impairment. It is written to cover the syllabus of the UK stroke specialist training programme and other similar programmes worldwide.
21
Allon, Michael. Haemodialysis. Edited by Jonathan Himmelfarb. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0256.
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Delivery of haemodialysis is dependent on having a vascular access that can reproducibly deliver an adequate blood flow thrice weekly. None of the three types of vascular access is perfect; each has potential advantages and drawbacks. Fistulas are the preferred type of vascular access because they have the longest cumulative survival and require the fewest interventions to maintain their long-term patency, once they achieve suitability for dialysis. However, fistulas have a fairly high non-maturation rate, frequently require revisions to achieve suitability for dialysis, and often are associated with prolonged catheter dependence until they are ready to cannulate. In contrast, grafts have a lower primary failure rate, are usually ready to use within 2–3 weeks of creation, and are therefore associated with a shorter duration of catheter dependence. However, the cumulative survival of grafts is shorter than that of fistulas, and they require more frequent interventions (angioplasty, thrombectomy, or surgical revisions) to maintain their patency for dialysis. The major advantage of dialysis catheters is that they are suitable for use as soon as they are placed. However, catheter use is associated with frequent complications, including catheter-related bacteraemia, dysfunction, and central vein stenosis. Many patients require a tunnelled dialysis catheter as a bridge, until they have a mature fistula or graft. Optimal management of vascular access is extremely challenging, and requires close collaboration among multiple medical disciplines, advance planning, and treatment or prophylaxis of their frequent complications.
22
Mokin, Maxim, Edward C. Jauch, Italo Linfante, Adnan Siddiqui, and Elad Levy, eds. Acute Stroke Management in the First 24 Hours. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190856519.001.0001.
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Diagnosis and treatment of acute stroke has advanced considerably in the past 2 decades. Most notably, in cases of ischemic stroke, intravenous alteplase has become the standard of medical treatment despite its multiple contraindications and limited time window. More recently, trials have proven that endovascular thrombectomy is superior to medical therapy alone, advancing the standard of care for patients who present with acute ischemic stroke from a large vessel occlusion and salvageable brain tissue. The treatment of hemorrhagic stroke now involves the use of novel pharmacological agents and advanced minimally invasive technology. Important changes have also occurred at the levels of hospital organization and treatment decision-making. Such changes in organization and designation of hospitals with distinct levels of stroke care and the variety of stroke protocols now requires team work of emergency medical services (EMS), Emergency Department, stroke neurologists, neurosurgeons, and neurointerventionalists. This book provides an overview of the modern medical and surgical options for the treatment of patients with acute ischemic and hemorrhagic strokes. The pivotal role of EMS in prehospital evaluation and triage of a stroke patient and the levels of stroke systems of care are discussed. In addition, the current guidelines on the management of acute stroke, with the focus on early care of acute stroke patients at the Emergency Department and the first 24 hours of hospital admission, are reviewed. Each chapter contains a discussion of common clinical scenarios including initial management steps, practical points, and common pitfalls.
23
Munshi, Sunil K., and Rowan Harwood, eds. Stroke in the Older Person. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780198747499.001.0001.
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Stroke in the Older Person will inform the readers about every aspect of stroke disease and traverses the entire stroke pathway. It explores all aspects of stroke and in particular those singular features of stroke that afflict older people. Nearly three-quarters of all strokes occur in people over the age of sixty-five. Each chapter is a synthesis of up-to-date work and practical approaches, relevant to stroke physicians, geriatricians, neurologists, researchers, doctors of all grades, physiotherapists, occupational therapists, speech and language therapists, advanced nurse practitioners, and neuropsychologists. The important themes addressed are the patient’s perspective, epidemiology, aetiopathogenesis, clinical presentations, diagnostic work-up including imaging, primary and secondary prevention, thrombolysis, mechanical thrombectomy, and all aspects of rehabilitation. It addresses transient ischaemic attack (TIA), atrial fibrillation, intracerebral haemorrhage, carotid revascularization, nutrition, and stroke mimics, dysphagia, the burden of cerebrovascular disease in the community, cognitive impairment, ethical and moral dilemmas including do not attempt resuscitation (DNAR), advanced directives, and end-of-life care. Stroke predominantly affects older people but there is a great shortage of literature in this age group. The editors have put together an excellent collection of chapters written by frontline clinicians or well-known academicians in their field. Special attention has been paid to make the book very readable, with plenty of practical tips. Only through a greater awareness of every aspect of stroke in older people can we make progress and treat our older people with the excellent care and dignity that they deserve.
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Brandt, Sebastian, and Hartmut Gehring. Anaesthesia for medical imaging and bronchoscopic procedures. Edited by Peter F. Mahoney and Michel M. R. F. Struys. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0077.
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Anaesthesia in ‘remote areas’ is required for medical imaging (CT, MRI, PET-CT), angiography, endoscopy, and interventions (stenting, thrombectomy, coiling, laser therapy, biopsies, radiotherapy) in a number of medical disciplines (paediatrics, radiology, cardiology, pulmonology, gastroenterology, surgery, cardiac surgery, emergency medicine). The spectrum of anaesthetic techniques is broad. It reaches from standby (monitored anaesthesia care), through analgesia and sedation (with spontaneous breathing), to general anaesthesia and mechanical ventilation. Regional anaesthesia techniques are also required under certain circumstances. In the last few years there has been a move away from open procedures to interventional techniques. The complexity of these interventions has increased (i.e. interventional cardiac valve replacements) and the patients tend to be older and suffer from a multitude of co-morbidities. Many of these interventions are performed in the ‘hostile environment’ of the intervention suite. Intervention suites are typically not designed to offer anaesthetists an ideal working area. The space may be limited and medical equipment impedes access to the patient. The infrastructure may be suboptimal (e.g. no central medical gases supply). Protection for staff and equipment against radiation and high magnetic fields must be considered. Loud noise from machinery and shielded walls, doors, and windows may hinder communication and hearing acoustic alarms. The distance to the operating theatre may be considerable and thus support from senior anaesthetists and supply of additional equipment may take some time to arrive. Anaesthesia outside the operating theatre is sometimes underestimated as trivial. Performing a ‘quick’ interventional case can evolve within seconds into a challenge even for the experienced anaesthesiologist if a surgical or anaesthesiological complication occurs. Non-operating-theatre anaesthesia has a higher severity of injuries and more substandard care than operating theatre anaesthesia. This is not acceptable and anaesthetists must ensure the same high standard of anaesthesia care and patient safety both inside and outside the operating theatre.
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Leys, Didier, Charlotte Cordonnier, and Valeria Caso. Stroke. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0067_update_002.
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Stroke is a major public health issue. Many are treatable in the acute stage, provided patients are admitted soon enough. The overall incidence of stroke in Western countries is approximately 2400 per year per million inhabitants, and 80% are due to cerebral ischaemia. The prevalence is approximately 12 000 per million inhabitants. Stroke is associated with increased long-term mortality, handicap, cognitive and behavioural impairments, recurrence, and an increased risk of other types of vascular events. It is of major interest to take the heterogeneity of stroke into account, because of differences in the acute management, secondary prevention, and outcomes, according to the subtype and cause of stroke. In all types of stroke, early epileptic seizures, delirium, increased intracranial pressure, and non-specific complications are frequent. In ischaemic strokes, specific complications, such as malignant infarcts, spontaneous haemorrhagic transformation, early recurrence, and a new ischaemic event in another vascular territory, are frequent. In haemorrhagic strokes, the major complication is the subsequent increased volume of bleeding. There is strong evidence that stroke patients should be treated in dedicated stroke units; each time 24 patients are treated in a stroke unit, instead of a conventional ward, one death and one dependence are prevented. This effect does not depend on age, severity, and the stroke subtype. For this reason, stroke unit care is the cornerstone of the treatment of stroke, aiming at the detection and management of life-threatening emergencies, stabilization of most physiological parameters, and prevention of early complications. In ischaemic strokes, besides this general management, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and before 4.5 hours, mechanical thrombectomy in case of proximal occlusion (middle cerebral artery, intracranial internal carotid artery, basilar artery), on top of thrombolysis in the absence of contraindication or alone otherwise, aspirin 300 mg, immediately or after 24 hours in case of thrombolysis, and, in a few patients, decompressive surgery. In intracerebral haemorrhages, blood pressure lowering and haemostatic therapy, when needed, are the two targets, while surgery does not seem effective to reduce death and disability.