Retrograde Angiography to Detect Dropped Thrombus in Mechanical Thrombectomy

Area of Science:

• Neurology
• Interventional Radiology
• Vascular Surgery

Background:

• Mechanical thrombectomy is crucial for acute ischemic stroke but faces challenges with dropped thrombi.
• Dropped thrombi can cause distal embolization, leading to poor patient outcomes.

Purpose of the Study:

• To introduce and evaluate a novel retrograde angiography technique for detecting dropped thrombi during mechanical thrombectomy.
• To assess the efficacy of this technique in preventing distal embolization.

Main Methods:

• A retrospective review of four patients undergoing mechanical thrombectomy for anterior circulation large vessel occlusion.
• The technique involves contrast injection via a microcatheter and aspiration through an inflated balloon-guiding catheter to detect thrombi at the catheter tip.

Main Results:

• The retrograde angiography technique successfully diagnosed dropped thrombus in three out of four patients.
• All diagnosed thrombi were retrieved, and successful reperfusion was achieved in all four cases.
• No instances of distal or new territory embolization occurred.

Conclusions:

• Retrograde angiography is an effective method for detecting dropped thrombi at the balloon-guiding catheter tip.
• This technique facilitates thrombus retrieval, potentially reducing embolization risks during mechanical thrombectomy.
• The technique shows promise for improving safety and efficacy in mechanical thrombectomy procedures.