Digital scan to erase the background and intervene to get cerebral thrombosis

The article is professionally consulted by Master, Doctor Le Xuan Thiep - Radiologist - Department of Diagnostic Imaging - Vinmec Ha Long International Hospital.

An ischemic stroke occurs when the blood supply to part of the brain is interrupted, preventing brain tissue from getting oxygen and nutrients. Brain cells will begin to die within minutes if not treated promptly. The treatment that has been proven effective at this time is digital imaging to erase the background and intervene to remove cerebral thrombosis. The blood flow is re-circulated, quickly improving the symptoms of weakness and paralysis for the patient.

Ischemic stroke is the most common type of stroke. The pathogenesis is when a blood clot blocks the flow of blood and oxygen to the brain, causing sudden weakness in one side of the face, arm, leg, difficulty speaking or even lethargy and coma if a brain infarction occurs. widespread.
These blood clots often form in areas where arteries have narrowed or become blocked over time by plaque. This is a consequence of the process of atherosclerosis.
Blood vessels tend to become narrower with age, but there are a number of factors that increase the risk of a stroke such as smoking, high blood pressure, obesity, high cholesterol levels, and diabetes. , drinking too much alcohol... Another cause of an ischemic stroke is when a person has a type of arrhythmia, called atrial fibrillation. This is a condition that causes blood clots to form in the heart and block blood vessels to the brain after any stroke.
The treatment of ischemic stroke includes early reperfusion therapy and long-term recurrence prevention. In particular, if you've had an ischemic stroke, a combination of drugs should be used to adjust your risk factors to prevent the event from happening again. At the same time, there are some drugs that need to be used immediately and only for a short time in order to increase blood volume and re-establish cerebral circulation.

Endovascular treatment of stroke is non-surgical treatment aimed at ameliorating the sudden loss of brain function due to blood clots by rapidly re-establishing cerebral circulation. Treatment involves the use of a microcatheter – a thin tube that can be seen under X-rays – inserted into and out of a blood clot in the brain away from the femoral artery in the groin or arm (brachial artery).
This whole process will happen in the background removal digitization studio. With the same mechanism as X-ray, which also uses X-rays, the image of the catheter will be continuously observed on the screen, helping the doctor adjust the path to approach as well as remove the clot. successfully. From there, blood flow continues to distribute to the brain parenchyma, signs of neurological defects will be improved.

After a thorough explanation of the procedure to be performed, the patient should fast, change into appropriate clothing and arrange to lie supine on the intervention table, place an intravenous line with saline solution 0, 9%. Means of monitoring breathing, pulse, blood pressure, electrocardiogram, SpO2 are mounted on the patient and the indicators are displayed on the screen for easy observation. After cleaning the inguinal and genital areas, the doctor will cover the area with a sterile tissue to prepare for the intervention. In case the patient is overstimulated and poorly cooperated, it is necessary to consider appointing a sedative to facilitate the process.
At the intervention site, the doctor will administer the usual local anesthetic in most cases from the femoral artery, unless this entrance is not possible, other routes are used. When the anesthetic takes effect, the doctor will insert a needle and insert the catheter into the artery. Under the background screen, the doctor adjusts and guides the catheter to the cerebral artery at the site of the thrombus.
When accessing a blood clot, depending on the case, the availability of facilities as well as the skill and experience of the doctor, the thrombectomy technician can choose one of the following three types of instruments :
Thromb aspiration kit: Approach the microcatheter to proximal thrombus. To achieve the highest thrombolytic effect, fibrinolytics can be injected into the thrombus at the post-, intra- and pre-thrombotic sites with a total dose not exceeding 6 mg. Then insert the push-pull drill to dissolve the thrombus and simultaneously connect the thrombus aspirator. Repeat several times until the thrombus is completely dissolved and signs of re-establishment of flow are observed on the fluorescence monitor.
Solitaire-type thrombectomy: Use a balloon-guided catheter with or without a balloon about 6-8F into the artery. When approaching the thrombus, continue to thread the microcatheter through the thrombus. Thread the Solitaire open at the position behind the thrombus, wait 5-10 minutes and proceed to inflate the balloon at the tip of the catheter and then pull the Solitaire. Check fluoroscopy, if recanalization, stop the procedure. Conversely, if not recanalized, the procedure can be repeated 2 to 3 times as above.
Mercie thrombectomy kit: Using an 8F catheter with balloon inserted into the artery. Continue threading the microcatheter through the site of the thrombus. Thread the thrombectomy kit behind the thrombus and then withdraw to allow the thrombus to get in and inflate the balloon. At the same time inflate the balloon and at the same time withdraw the thrombus into the catheter to bring it out.
After observing that the blood clot is removed from the lumen, it is necessary to re-evaluate whether the lumen has been completely recanalized by injecting contrast and observing on the screen digitally erasing the background. The lumen is completely recanalized or may not be completely recanalized with the residual stenosis allowed not to exceed 30% of the lumen diameter at the same site. At the same time, the artery segment before, during and immediately after the recanalization segment must also be observed with normal flow, without any sign of thrombosis or dissection.

Because this is a rather sophisticated procedure, requiring high technology and experienced staff, all complications of cerebral thromboembolism intervention should be explained clearly and in detail to the patient and family. family before intervention.
Besides, on the professional side, it is very important to be aware early when a complication occurs after the intervention to remove cerebral thrombosis to avoid significantly affecting the outcome of the intervention. Therefore, the neurologist needs to be familiar with these complications and know how to manage them. Complications of interventional thromboembolism are common as follows:
Brain hemorrhage: Because cerebral hemorrhage significantly increases patient morbidity and mortality, this is the most feared complication after intervention. card. Intracerebral hemorrhage can also occur secondary to cerebral parenchymal reperfusion following infarction. Besides, this complication can also be caused by direct damage to the vessel wall by the interventional instruments.
Thrombosis in place: Thrombosis in place during endovascular intervention is a prominent complication and also accounts for a large proportion of cases with worsening neurological status. This may be a consequence of an intervention that activates coagulation as well as platelet activation.
Air embolism: Although air embolism during neurovascular procedures rarely causes symptoms, it has been identified as a cause of postoperative neurological deficits. The origin of air embolism can be from arterial blood flow or when negative pressure is used to aspirate the thrombus.
Distal embolization: The risk of further migration of debris from the clot is a concern during manipulation to remove the clot. The brain will experience infarction secondary to blockages in many smaller arteries.

Vasoconstriction: Manipulations performed on catheters in the lumen of cerebral arteries are factors that stimulate vasoconstriction.
Carotid artery fistula: Forming a fistula is also a complication during the interventional manipulation of cerebral thrombosis.
In summary, ischemic stroke is a medical emergency and prompt treatment is crucial. Early action can reduce brain damage and other complications. In particular, digital imaging to erase the background and intervention to remove cerebral thrombosis with the above information is an important measure, which should be taken immediately upon admission to achieve the highest treatment efficiency, minimize the occurrence of thromboembolism. complications, bring good outcomes for patients.
Dr. Le Xuan Thiep has strengths in performing advanced and difficult magnetic resonance and computed tomography techniques such as: coronary computed tomography, cardiac function, cerebral magnetic resonance, perfusion brain and organs,..
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