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Can Endovascular Neurosurgery Be Used To Remove Embolic Clots?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Embolic clots can be removed in certain circumstances. First condition is for the clot to be stuck in a major vessel, like the carotid, middle cerebral or basilar artery. If the clot is located in a more distant peripheral vessel then it is not possible to reach that far and remove it.
The second condition is the time factor. The aim of removing the embolic clot is to restore circulation, but if there has been no circulation for 6 hours the tissue is already damaged, there is no gain, may even cause more damaged as when blood reenters the by now dead area it may cause a hemorrhage. So this intervention is done when in the first 6 hours, not afterwards (rarely may be extended by a few more hours when special perfusion imaging - not available in every center - shows there is still tissue to be salvaged by reopening the vessel).
So these are the two main conditions, the vessel involved and the 6 hour limit. Of course it is looked also at the general condition of the patient, kidney failure, other serious diseases and life expectancy. At times there may be technical limitations in individual patients such as vessels being very tortuous or very long occlusions which can not be accessed by the physician performing the procedure.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Embolic clots can be removed in certain circumstances. First condition is for the clot to be stuck in a major vessel, like the carotid, middle cerebral or basilar artery. If the clot is located in a more distant peripheral vessel then it is not possible to reach that far and remove it.
The second condition is the time factor. The aim of removing the embolic clot is to restore circulation, but if there has been no circulation for 6 hours the tissue is already damaged, there is no gain, may even cause more damaged as when blood reenters the by now dead area it may cause a hemorrhage. So this intervention is done when in the first 6 hours, not afterwards (rarely may be extended by a few more hours when special perfusion imaging - not available in every center - shows there is still tissue to be salvaged by reopening the vessel).
So these are the two main conditions, the vessel involved and the 6 hour limit. Of course it is looked also at the general condition of the patient, kidney failure, other serious diseases and life expectancy. At times there may be technical limitations in individual patients such as vessels being very tortuous or very long occlusions which can not be accessed by the physician performing the procedure.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you.
May I also ask if there is any legitimate reason to delay CT Scan when the patient is showing clear signs of difficulty--facial droop, right sided weakness?
May I also ask if there is any legitimate reason to delay CT Scan when the patient is showing clear signs of difficulty--facial droop, right sided weakness?
Brief Answer:
Read below.
Detailed Answer:
No, if the patient was otherwise stable for transport to the machine, I do not see any reason not to perform a CT scan really.
In the first few hours the CT may not show the lesion mind you (perhaps that is why it wasn't done, thought that it wouldn't show much), but however it can exclude the possibility a hemorrhage which might manifest in an identical way and if done with contrast it may also evidence the occlusion of major vessels (which as I said would be subject to intervention). So the only scenario it can be postponed for some hours in order to get a better view of the extension of the damage is when the clinician is certain for it to be an ischemic lesion and not a hemorrhage, as well as to be certain it is not a major vessel. But since you can't be that certain, most common practice is to have a CT right away and another control CT later on.
Let me know if I can further assist you.
Read below.
Detailed Answer:
No, if the patient was otherwise stable for transport to the machine, I do not see any reason not to perform a CT scan really.
In the first few hours the CT may not show the lesion mind you (perhaps that is why it wasn't done, thought that it wouldn't show much), but however it can exclude the possibility a hemorrhage which might manifest in an identical way and if done with contrast it may also evidence the occlusion of major vessels (which as I said would be subject to intervention). So the only scenario it can be postponed for some hours in order to get a better view of the extension of the damage is when the clinician is certain for it to be an ischemic lesion and not a hemorrhage, as well as to be certain it is not a major vessel. But since you can't be that certain, most common practice is to have a CT right away and another control CT later on.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your help.
Brief Answer:
You're welcome.
Detailed Answer:
I do not know the details of the case but I hope things work out for the best.
You're welcome.
Detailed Answer:
I do not know the details of the case but I hope things work out for the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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