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1、3/13/2012AdvancesinEndovascularTreatmentofAcuteStrokesRichardP.Klucznik,M.D.OrlandoDiaz-Daza,M.D.AcuteStrokeKitchenSinkProtocol•Usewhateverittakestogetvesselevenpartiallyopen,angioplasty,macerate,push,shove,retrievetogetbiggervesselsopenandallowthrombolyticsabettersurfaceareatoworkandallowdrugstow
2、orkonsmallervessels13/13/2012PREPOSTThrombolysis•Intra-arterialUrokinase•Intra-arterialTPA–Reteplasehaslongerhalflife•Intra-arterialReopro•rPro-UK(Pro-ACTstudy)•Desmoteplase(vampireBat)•DirectFibrinolyticsENDOVASCULARTREATMENTOFSTROKEINTRA-ARTERIALINFUSIONUrokinaseAvailableDevices•BALLOONS•RETRIEV
3、ALDEVICES•Keepinmindthatballoonsaremadeforaneurysmtreatment,spasm,etcandretrievaldevicesexceptforMerciandPenumbraaremadeforretrievingwaywardcoils,etc.•ThiswasofflabeluseofthesedevicesBalloons•58yearoldmalewithbasilarstenosis,48hoursafteruneventfulstenting•SomequestionastowhethertheptmissedadoseofP
4、lavix•24hoursafterNOVAMRAscan•BalloonAngioplastyandreopro23/13/2012InitialAngiogram48hoursafterStentingFollowupAngiogram24hoursRetrieversRetrievalDevicesAmplatzGoosenecksnare–ev333/13/2012ClotAngioplasty,Neuronet,Snare(beforeMerciwasavailable)•77yearoldfemalewithAfibwokeupblind•Nolightperceptionon
5、exam•Seenatanotherhospitalfirst•MRIwithdiffusion/perfusionshowsmismatchonrightoccipital,butmatcheddefectontheleftGooseNeckMicrosnareAlligatorRapidIntracranialClotRemovalwithaNewDevice:TheAlligatorRetrieverGiddyUpC.W.Kerbera,I.Wankeb,J.Bernard,Jr.c,H.H.Wood,M.W.LiueandP.K.NelsonfRetrievedCoil43/13/
6、2012CTsamedayLetusnowlookatdevicesthatdesignedspecificallyforacutestrokeclotretrievalRetrievalDevicesFindit,Engageit,RetrieveitMerciRetriever-ConcentricPenumbraAspirationdeviceNeuronet–GuidantIn-Time–BostonScientificAmplatzGooseNeck-Microsnare–ev3MiniEnSnare–MDTech(notrecommended)Future53/13/2012M
7、ERCIRetriever59yomalewithacutehemiparesisonawakeningPenumbraAspirationSystem63/13/2012AspirationSystemMatched041Separator™ReperfusionCatheter041Matched032SeparatorReperfusionCatheter032Matched026SeparatorReperfus
