Neurointervensi RSUD Dr Wahidin Sudirohusodo Mojokerto: Neuroimaging, Neurologist View

Neurointervensi RSUD Dr Wahidin Sudirohusodo Mojokerto: Neuroimaging, Neurologist View: http://www.slideshare.net/teddywijatmikosps/neuroimaging-teddy

Neuroimaging, Neurologist View

http://www.slideshare.net/teddywijatmikosps/neuroimaging-teddy

Gradient Echo sensitive mendeteksi perdarahan akut

MRI brain gradient-recalled echo 3.0-T at baseline. Acute right frontal hematoma (thick arrow) in the setting of multiple cortical lobar microbleeds (arrowhead) with a right hemisphere parieto-occipital predominance, as well as a chronic left parietal chronic slit-like hemorrhage (thin arrow).

mekanikal trombektomi dan gbIIb/IIIa pada stroke trombosis arteri basilaris

Pria , 38 th
kesadaran menurun mendadak, 5 jam sebelum MRS, perokok berat,
GCS 225, tensi 140/80, rr 26 x/mnt, afebril, nadi 70x/mnt
MRI DWI infark cerebelum.
DSA dilakukan dengan anestesi penuh dan didapatkan sumbatan arteri basilaris TICI 0, serta tidak nampak kedua PCOM.
Dilakukan mekanikal trombektomi dengan menggunaikan solitaire sehingga menjadi TICI 2.
dilanjutkan dengan pemberian tirofiban 10 ml (tirocip 5m/100 ml) dan didapatkan hasil TICI 3.
Pasen dapat menoleransi penuh tindakan.

Gambaran DWI nampak area hiperintens di cerebelum.

prosedur DSA

bahan ;

1. 2% lignocaine loaded in 10 ml syringe
2. 5F arterial sheats (grey)
3. puncture needle (16G/18G)
4. 5 diagnostic cath headhunter 1 atau picard

kejang status saat prosedur intervensi

saat kejang :
hentikan kejang dg :

1. diazepam intravena 1 ampul (10 mg) dlm 10 ml NS dimasukkan dg kecepatan 5 mg/menit sampai kejang berhenti maksimal 20 mg.

hipertensi pada prosedur neurointervensi

hipertensi saat prosedur intervensi merupakan kondisi yang berbahaya, bisa menyebabkan krisis hipertensi dengan segala akibatnya.

Khusus pada prosedur neurointervensi tekana darah yang tinggu menyebabkan luka pungsi arteri femoral mudah perdarahan karenanya harus dikontrol.  ada dua obat yaitu labetolol dan nitrogliserin.

hipotensi pasca angioplasti carotis

pasca prosedur dengan angioplasti carotis (inflasi balon) sering pasen mengalami bradikardia dan hipotensi, untuk mencegahnya pada pasen dg heart rate < 60 kali per menit

perlu diberi atropin 0,5-0,75 mg, atau setelah angioplasti mengalami bradikardiperlu diberi atropin dg dosis yang sama.

angioplasty and stenting

Procedure angioplasty and stenting

Materials
1. 2% lignocaine loaded in 10 ml syringe
2. 7F arterial sheats(orange)
3. puncture needle (16G/18G)
4. 5 F/6 F diagnostic cath, 

5. Standart length  wire 0,035"150 cm ((terumo)

6. Exchange guidewire 0,035" 300 cm
7. Guiding cath7F acculink

8. Baloon cath (viatrac 14 plus)

9. Stent (Xact)
10. 3 way stopcocks
11. small bowl
12. large bowls with heparinized saline 1.000 units/ 500 ml saline
13. pressure saline bags with heparinized saline 10.000 units/1 liter each-->two bags
13. contrast non ionic (omnipaque)
14. 10 ml syringe 3

technique
1. insert anestesia, insert needle
2. insert 7 F arterial sheath
3. 2.000 heparin iv
4. if tortuous vesels: insert diagnostic cath first
    if good vessels : directly insert guiding cath
5. After reaching CCA-->park exchange wire (terumo 300 cm, 0,035"/0,038") in  ECA
6. place guiding cath into infra petrousal ICA--> connect with saline bags by 3 waystopcocks making coaxial system
8. negotiate microwire acros stenosis (Hi Torque 0,014" 190 cm)

9. Placement of embolic protecting device if required

10. advancement of stent over the microwire wth aproriate placement of stent across the stenosis covering the full length of stenosis.

11. deployment of the stent and removal of stent accessories. Check the stent position under roadmap or cine or in unsubstracted images as per bony landmark.

12. preatropinitation before balloon dilatation to prevent bradicardia.

13. insertion of balloon cath for angioplasty across the stenosis followed by dilatation usually up to 6-8 atm for 10-30 s.

14. postangioplasty angiogram to look for flow across the stent and any redidual stenosis. Make sure there is no residual stenosis and there is good stent apposition across the wall. There should not be any cut off the vessels in neck and circle of willis angiogram.

Prosedur coiling

Materials
1. 2% lignocaine loaded in 10 ml syringe
2. 7F arterial sheats(orange)
3. puncture needle (16G/18G)
4. 5 F/6F diagnostic cath
5. Standart length guide wire 0,035"150 cm
6. Exchange guidewire 0,035" 300 cm
7. Guiding cath7F acculink
8. microcatheter Excelsor SL-10 straight (ID: 0,0165 in)
9. microwire Transend EX (OD : 0,014 in)
10. 3 way stopcocks
11. small bowl
12. large bowls with heparinized saline 10.000 units/1 liter
13. pressure saline bags with heparinized saline 10.000 units/1 liter each-->two bags
13. contrast non ionic (omnipaque)
14. coil

technique
1. insert anestesia, insert needle
2. insert 7 F arerial sheath
3. 2.000 heparin iv
4. if tortuous vesels: insert diagnostic cath first
    if good vessels : directly insert guiding cath
5. After reaching CCA-->park exchange wire (terumo 300 cm, 0,035"/0,038") in  ECA
6. place guiding cath into infra petrousal ICA--> connect with saline bags by 3 waystopcocks making coaxial system
8. place microcath over microwire into desired aneurysm