Flow-guided catheter

The Penumbra stroke system (Penumbra Inc., San Leandro, CA) includes two different revascularization options (1) thrombus debulking and aspiration may be achieved by a reperfusion catheter that aspirates the clot while a separator device fragments it, and (2) direct thrombus extraction may be performed by a ring retriever while a balloon guide catheter is used to temporarily arrest flow. This system has been tested in a pilot trial in Europe. Twenty patients (mean NIHSS 21) with a total of 21 vessel occlusions (7 ICA, 5 MCA, and 9 Basilar) were treated up to 8 hours after symptom onset. Recanalization prior to lA lysis was achieved in all cases (48% TIMI 2 52% TIMI 3). Seven patients were also treated with lA UK or rt-PA. Good outcome at 30 days (defined as mRS < 2 or NIHSS 4-point improvement) was demonstrated in 42%. The mortality rate was 45%, but there were no device-related deaths. There was one asymptomatic SAH and three symptomatic ICHs. A prospective, single-arm, multicenter trial is being conducted in the United States and Europe currently. 

For this application, a sterile microdialysis catheter is implanted percutane-ously into the subcutaneous adipose tissue in the periumbilical region using a special stainless steel guide cannula (Rosdahl et al., 1993). The membrane length of 2 to 3 cm and flow rates of 0.1 to 0.5 piL/min should guarantee sufficiently long dialysis time to achieve 100% recovery. Another approach is to use a flat dialysis probe for transcutaneous applications (DeBoer et al., 1993 Korf et al., 1993). Here the skin of newborn babies is first partially removed by stripping with medical tape. Then a microdialysis probe is placed directly onto the exposed skin, usually on the abdomen lateral to the umbilicus (DeBoer et al., 1994). 

The ReviveFlow system (ReviveFlow, Inc., Quincy, MA) is a novel method of cerebral flow reversal in which a balloon guide catheter is placed in the cervical internal carotid arteries and jugular veins on one or both sides of the neck. The balloons are subsequently inflated and blood is aspirated via an external pump system from the proximal 1C A and infused in the distal internal jugular vein. The end result is total reversal of the cerebral circulation and perfusion of the venous system with arterial blood into the capillary bed, which is now physiologically proximal to the occluded artery. This device is currently undergoing precliifical smdies. 

Fig.SJ Kit for pericardiocentesis Usually contains high-flow pigtail or straight catheter dilator three-way stopcock guide wire double-ended (J straight) different kinds of needles different kinds of Luer-lock syringes a bag with connecting tube gauzes fenestrated drape absorbent barrier a double-ended alligator-clip cable...

In our experience, use of vasodilators in the presence of spasm was not very helpful. When spasm occurs, the guiding catheter needs to be pulled out of uterine artery until the spasm is resolved. Sometimes the microcatheter should be pulled out of uterine artery as well. In cases of persistent spasm of the left uterine artery, one can remove the catheter and proceed to the embolization of the right uterine artery before re-catheterization of the left side. If a flow-limiting spasm persists, the use of smaller sized... 

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