Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan.
World Neurosurg. 2020 May;137:229-234. doi: 10.1016/j.wneu.2020.01.233. Epub 2020 Feb 5.
When endovascular clot retrievals are performed using a stent retriever and/or an aspiration catheter, identifying the accurate position of a clot is extremely important for a successful immediate recanalization. Herein, we report a new technique called microcatheter withdrawing angiography, which facilitates the identification of the precise position of a clot. The negative shadow appearance of the clot on angiography was referred to as the actual crab claw sign.
When a 0.027-inch microcatheter penetrated the clot after inserting a 0.014-inch microwire, selective angiography was conducted using the microcatheter. Simultaneously, the microcatheter was slowly withdrawn with continuous contrast media injection, while the microwire was kept in the distal vessel. The precise position of the clot was found, which was referred to as the actual crab claw sign. Next, we conducted in vitro and in vivo analyses.
The actual crab claw sign could be identified in the vascular model and in actual clinical settings. Therefore the sweet spot of the stent retriever could be set over the clot, and an accurate contact aspiration could be performed using an aspirator.
Microcatheter withdrawing angiography can help identify the actual crab claw sign. This technique has a higher success rate and faster recanalization than conventional strategy, particularly in challenging cases of unsuccessful recanalization during the first attempt.
在使用支架取栓器和/或抽吸导管进行血管内血栓清除时，准确识别血栓的位置对于实现即刻再通至关重要。在此，我们报告一种新的技术，称为微导管回撤造影，有助于确定血栓的确切位置。血管造影上的血栓负影表现称为实际蟹爪征。
在将 0.014 英寸微导丝插入后，当 0.027 英寸微导管穿透血栓时，使用微导管进行选择性血管造影。同时，在连续注入造影剂的情况下，缓慢撤回微导管，而微导丝保持在远端血管内。找到血栓的确切位置，称为实际蟹爪征。然后，我们进行了体外和体内分析。
在血管模型和实际临床环境中都可以识别出实际蟹爪征。因此，可以将支架取栓器的理想位置设置在血栓上，并使用抽吸器进行准确的接触抽吸。
微导管回撤造影有助于识别实际蟹爪征。与传统策略相比，该技术的成功率更高，再通速度更快，特别是在首次尝试不成功的情况下。
