Mechanical clot disruption

Barnwell SL, Clark WM, Nguyen TT, O Neill OR, Wynn ML, Coull BM. Safety and efficacy of delayed intraarterial urokinase therapy with mechanical clot disruption for thromboembolic stroke. Am J Neuroradiol 1994 15 1817-1822. 

Fig. 8.6 Postischemic hyperperfusion. The patient is a 77-year-old man who is status post successful dissolution of an embolus that had occluded the supracbnoid left internal carotid artery and proximal left anterior and middle cerebral arteries, by a combination of intravenous and intra-arterial injection of thrombolytic drugs, and mechanical clot disruption. The DWI image shows a large infarct in the left middle cerebral artery (MCA) territory.

Qureshi, A.I., et al., Aggressive mechanical clot disruption and low-dose intra-arterial third-generation thrombolytic agent for ischemic stroke a prospective study. Neurosurgery, 2002. 51(5) p. 1319-27 discussion 1327-9. 

There are several techniques available for mechanical thrombolysis. The most common is probing the thrombus with a microguidewire. This technique appears to be useful in facilitating chemical thrombolysis. Alternatively, a snare (e.g., Amplatz Goose-Neck Microsnare, Microvena, White Bear Lake, MN) can be used for multiple passes through the occlusion to disrupt the thrombus. " A snare can also be used for clot retrieval, mostly in simations in which the clot has a firm consistency or contains solid material. ... 

Blood compatibility. It is important that cellular components of the blood are not disrupted and that serum- or plasma-based responses are not triggered by parenteral administration. Therefore, two mechanisms must be assessed regarding the blood compatibility of component materials. These include the material s effect on cellular components that cause membrane destruction and hemolysis and the activation of the clotting mechanism resulting in the formation of the thromboeboli. 

Another advantage of angiography during acute stroke treatment is that it allows mechanical disruption of the clot. There are several methods available today. Among them are angioplasty balloons, clot extraction devices (corkscrew retriever MERCI device), ultrasound aided catheters and simple manipulation of the clot... 

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