Flow control technique to prevent distal embolization during mechanical thrombectomy Mathew Wooster, MD, Daniel Kloda, DO, Jacob Robison, MD, Joseph Hart,

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Presentation transcript:

Flow control technique to prevent distal embolization during mechanical thrombectomy Mathew Wooster, MD, Daniel Kloda, DO, Jacob Robison, MD, Joseph Hart, MD, Marcelo Guimaraes, MD, Thomas Todoran, MD, Claudio Schönholz, MD Journal of Vascular Surgery Volume 56, Issue 5, Pages 1457-1460 (November 2012) DOI: 10.1016/j.jvs.2012.06.100 Copyright © 2012 Terms and Conditions

Fig 1 A, Complete unilateral occlusion of aortobifemoral bypass graft. B, Placement of a balloon occlusion catheter at the aortic bifurcation (1) via the nonoccluded limb and of a Gore Flow Reversal (GFR) catheter immediately distal to the takeoff of the hypogastric artery (2) creates flow control. C, Crossing of the lesion while under flow control. D, Mechanical thrombectomy of the occluded limb while under flow control is performed through the GFR catheter. E, Active aspiration of the macerated thrombus to remove clot burden before deflating occlusive balloons. F, Restoration of bilateral flow through the aortobifemoral bypass graft. Journal of Vascular Surgery 2012 56, 1457-1460DOI: (10.1016/j.jvs.2012.06.100) Copyright © 2012 Terms and Conditions

Fig 2 Six-month status post-endovascular mechanical thrombolysis with bilateral iliac bare metal stent placement and 1-year status post-aortobifemoral bypass graft placement patient presented with left leg claudication. Computed tomography angiogram demonstrated occlusion of the left limb of the bypass graft with reconstitution distally and normal patency of the right graft limb. Journal of Vascular Surgery 2012 56, 1457-1460DOI: (10.1016/j.jvs.2012.06.100) Copyright © 2012 Terms and Conditions

Fig 3 A, Initial aortogram using a KMP catheter advanced across the lesion over a 0.035-in wire demonstrates total occlusion of the left limb of the aortobifemoral bypass graft with patency of the right limb. B, A balloon occlusion catheter was advanced via the right limb (white arrow), and the cerebral flow reversal Gore balloon sheath was advanced via the occluded left limb such that the balloon was just distal to the iliac bifurcation (black arrow). C, Inflation of both balloons provided distal flow control via the left limb and contralateral embolic protection via the right limb while the Angiojet was advanced through the flow reversal catheter and mechanical thrombectomy performed. During thrombectomy, a syringe was used to aspirate residual thrombus via “reversed flow” because a true venous shunt was not created. D, Completion aortogram showing bilateral patency of aortobifemoral bypass graft. Journal of Vascular Surgery 2012 56, 1457-1460DOI: (10.1016/j.jvs.2012.06.100) Copyright © 2012 Terms and Conditions

Fig 4 Aspiration of residual clot under flow control is safe and effective. The flow reversal catheter was designed for use in carotid interventions, and a shorter length would be more appropriate for lower extremity procedures. Heavy clot burden associated with aortoiliac disease (inset). Journal of Vascular Surgery 2012 56, 1457-1460DOI: (10.1016/j.jvs.2012.06.100) Copyright © 2012 Terms and Conditions