AIS means permanent blockage of blood supply to brain causing ischemic symptoms which not recover spontaneously. We need to open the artery soon to prevent permanent deficit.
TIA means temporary blockage of blood supply to brain causing ischemic symptoms which recover spontaneously over few minutes. It is usually precursor of major stroke.
All acute ischemic strokes should be treated urgently. Time is brain, so earlier we open the artery better are final results.
AIS can be treated either by IV Thrombolysis or Mechanical Thrombectomy.
Vessel occluded |
% of patients in which revascularization is achieved by |
ICA |
9% |
M1, BA, VA |
35% |
M2 |
54% |
M3 |
66% |
Indications of Mechanical Thrombectomy are
1. Patient come within 8-24hrs
2. ASPECT score of 6 or more on CT scan or MRI
3. Large artery occlusion
Patient can be started on IV rt-PA and then shifted to cath lab for mechanical thrombectomy.
There are two methods of mechanical thrombectomy: Stent Retrieval and Aspiration. Both can be used together also.
STENT RETRIEVAL TECHNIQUE (M1 OCCLUSION)
Step 1: Femoral artery is punctured and sheath is placed in femoral artery. Then through it guiding catheter is placed into neck vessel.
Step 2: Then the device (green) is taken through guiding catheter in MCA and thrombus is caught.
Step 3: Device with thrombus is taken out.
Step 4: Finally guiding catheter and sheath are removed.
ASPIRATION TECHNIQUE (BASILAR ARTERY OCCLUSION)
Step 1: Femoral artery is punctured and sheath is placed in femoral artery. Then through it guiding catheter is placed into neck vessel.
Step 2: Then the aspiration catheter (green) is taken through guiding catheter in Basilar Artery in thrombus.
Step 3: Aspiration is started and thrombus is sucked out.
Step 4: Finally aspiration catheter, guiding catheter and sheath are removed.
CASE 1: 40yrs male with posterior circulation stroke, Time of Onset: 2hrs. Basilar artery occlusion
CASE 2: 51yrs female with posterior circulation stroke. Time of Onset: 3.5hrs. Basilar artery occlusion