0:01

We have a case of a patient

0:02

who presents with a stroke.

0:04

She had systemic TPA, sudden onset of

0:07

not responding and right-sided weakness.

0:09

So, she has what we call left MCA

0:11

syndrome that's being suspected.

0:14

She received her systemic TPA, taken Angio,

0:17

and the whole goal in this particular

0:19

setting is for mechanical thrombectomy.

0:21

So what we see here is essentially this large

0:23

defect, which is important to note.

0:26

But again, we talk about landing

0:28

our plane, so let's land

0:30

our plane after a procedure like this.

0:31

So the right common femoral artery was utilized

0:33

for the procedure, so when we get the angiogram in

0:36

preparation for maybe deploying a closure device.

0:38

So what do we see?

0:41

So we'll look at that again.

0:46

So what we see here is actually just some clots

0:49

and filling defects along the course of our sheath.

0:53

So, what are we concerned about?

0:56

Well, we're worried about thrombosis.

0:58

We don't want our sheath, which is essentially

1:01

something that's in the vessel, that's

1:03

taken up space, to have clot formation.

1:05

You know, when there's greater than 50

1:06

percent reduction in the diameter of the

1:07

artery, that's hemodynamic significance.

1:10

Um, that's a reduction of greater

1:12

than 75 percent of the cross-sectional area.

1:14

So, that's a high risk for occlusion.

1:16

So, we want to be mindful of that,

1:17

as that could

1:18

precipitate thrombosis.

1:20

So after a successful procedure, the thrombus

1:23

actually did not spontaneously resolve.

1:25

So, what are we thinking here?

1:27

It's still present, so what do we want to do?

1:32

So, you know, what was thought by the

1:35

neurointerventionalists is like, okay, we're

1:37

going to remove the access sheath.

1:40

We're just going to apply manual compression,

1:41

and that's what they did.

1:42

They applied it, and it ended up being 40 minutes.

1:45

Presumably that clot was still present and

1:47

they pulled out their access, but they held

1:50

pressure for so long, they had a Doppler

1:52

on the foot, they made sure that there

1:54

was nothing compromised in terms

1:56

of the access, the signal at the foot.

1:58

They made sure that they had access

2:00

and felt that they had a strong pulse

2:03

where they were applying manual compression.

2:05

Um, but again, it lasted for 40

2:06

minutes, but ultimately the patient

2:09

suffered no further complications.