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So let's look at a case, 63-year-old male, history of

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hypertension, diabetes, hyperlipidemia, schizophrenic,

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now presenting with middle cerebral artery stroke.

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And so, a CTA is performed, we have a left and right

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M1 segment chronic occlusion, and this patient was

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transferred to neuro IR for mechanical thrombectomy.

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So, in order to achieve that thrombectomy,

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of course, common femoral artery

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access was selected for the procedure.

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So, during the procedure, what we end up

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seeing is this angiogram that was obtained

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at the right common femoral artery access.

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Let's take a peek.

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So, what do we see here?

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So, what we see is the following.

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What do we consider this to be?

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That's thrombus.

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That's a filling defect just at the tip of the sheath.

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Here's the sheath.

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Here's contrast flowing around

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this little globule of thrombus.

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And that's particularly curious.

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So let's take a look here.

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So what does the neuro IR do in the interim?

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Neuro IR actually proceeds with anticoagulation,

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therapeutic, in the presence of that thrombus.

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The neuro IR attempts to aspirate that clot

1:28

from the tip of the sheath and ends up having

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a result that demonstrates interval resolution.

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Success?

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Or no success.

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I would say success.

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So what are we doing here?

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And what are the things that we need to consider?

1:45

So, procedure is successfully completed.

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But then a vascular closure device was deployed

1:50

unsuccessfully and a moderate-sized hematoma formed.

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So what should you do next?

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From one issue to another issue.

1:56

So how do you want to manage this?

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Well, let's go ahead and do the

1:59

old-fashioned manual compression.

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Let's check our popliteal and pedal pulses, make

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sure all is good, because again, the patient was

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anticoagulated after we saw that thrombus, so we want

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to make sure that we are getting good hemostasis.

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But what we noticed was there's reduced

2:14

right popliteal and pedal arterial pulses.

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So we consult the vascular surgery,

2:18

but then they said, you know what?

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No intervention needed, gentlemen.

2:21

What we're going to recommend is,

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you know, the fact that this patient's

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asymptomatic and no acute limb ischemia.

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Just, just, just let it ride.

2:28

And the patient actually did quite well post-procedure.

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So, let's review a few things.

2:34

Hemorrhage can actually present with dizziness,

2:36

orthostatic hypotension, ipsilateral regional plan,

2:39

as well as a serial decrease in hemoglobin.

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CT is used for the diagnosis

2:44

of hematoma and hemorrhage.

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Resistance to sheath and catheter advancement should

2:48

actually prompt angiographic evaluation immediately.

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If you actually experience hemorrhage and

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there's a growing hematoma, they should be

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treated immediately, because large hematomas

2:59

can actually be managed with a blood pressure

3:02

cuff to the forearm or pressure dressings.