Thrombectomy Technique Research Articles

Abstract WMP70: Etiology of Stroke Based on Early Analysis of Clot Cytometry Obtained Through First Pass Technique for Mechanical Thrombectomy

Introduction: Mechanical thrombectomy is the best treatment for large vessel occlusion in acute strokes, this technique can obtain clots for further analysis. Objective: To evaluate flow cytometry in thrombi obtained in the treatment of hyperacute stroke by mechanical thrombectomy, as a diagnostic tool in the etiological study of stroke Methods: Consecutively, intracranial clots were obtained in the hyperacute phase of stroke with solitaire device. Cell suspensions of thrombi were prepared that were labeled by direct immunofluorescence using conjugated monoclonal antibodies. The labeled samples were acquired in a Naviostm flow cytometer (Beckman-Coulter). The following leukocyte populations were studied: granulocytes, monocytes, total lymphocytes, T lymphocytes (CD3 +), helper T lymphocytes (CD3 +, CD4 +), suppressor-cytotoxic T lymphocytes (CD3 +, CD8 +), TNK lymphocytes (CD3 +, CD56 / 16 +) , NK lymphocytes (CD3-, CD56 / 16 +) and B lymphocytes (CD19 +). The results were expressed as percentages (%). The aetiology of stroke was categorized in secondary to: major structural heart disease, atrial fibrillation, stroke of atherosclerotic etiology (severe stenosis or complicated aortic atheromatosis ulceration) or infrequent causes. Results: 40 samples were analyzed. Clots of atherosclerotic etiology (n = 13) were associated with higher% of CD4 T lymphocytes (24.85% vs 15.83% p = 0.016), and higher% of NK (21.08% vs 17.04) % p = 0.07), also showed a tendency to a higher% LT (23.69% vs 16.46% p = 0.052). Strokes secondary to AF were associated with a higher percentage of CD8 T lymphocytes (20.24 vs 13.56 p = 0.048). Conclussion: Analysis by flow cytometry of clots obtained in the hyperacute phase of stroke showed significant differences in the different lymphocyte populations according to the etiology

The Aspirations of Direct Aspiration for Thrombectomy in Ischemic Stroke: A Critical Analysis.

The treatment of acute ischemic stroke by mechanical thrombectomy has been revolutionary, however most of the clinical trials were done with the use a stent retriever. At the same time, an alternative technique of thrombectomy through direct aspiration with a large bore distal access catheter at the face of the clot is rapidly gaining popularity. Nonetheless, the data supporting this new technique is not yet as mature as that available on stent retrievers. This review is a critical analysis of the evidence supporting the principle of direct aspiration thrombectomy and a discussion of its potential strengths and weaknesses in comparison to the available studies on stent retrievers. While this is by no means a conclusive review, it should serve as a yardstick of where the science is currently, and what are the next trials that are necessary.

Comparing Thrombectomy Techniques: Combination Use of Stent–retriever and Aspiration Catheter vs. Conventional Use of Stent–retriever

Comparing Thrombectomy Techniques: Combination Use of Stent–retriever and Aspiration Catheter vs. Conventional Use of Stent–retriever

A Retrospective Single-Center Case Series of Direct Aspiration Thrombectomy as First-Line Approach in Ischemic Stroke and Review of the Literature

The benefit of the direct aspiration thrombectomy (ADAPT) technique for the treatment of ischemic stroke due to large vessel occlusion are challenged after publishing of the ASTER trial that failed to show superiority of ADAPT compared to stent retriever. Aim of the present single-center study was a retrospective evaluation of the ADAPT technique comparing our results with literature. We retrospectively analyzed institutional data of stroke procedures in patients with mainstem occlusion of the middle cerebral artery treated between November 2016 and December 2017 with an initial attempt of manual thrombaspiration. Reperfusion rate (thrombolysis in cerebral infarction), procedural times, early clinical outcome and complications were recorded. Forty patients were treated by using direct thrombaspiration in middle cerebral artery mainstem occlusion. Median age was 67.5 (±17.8) years (m = 27.5%). Median Baseline National Institutes of Health Stroke Scale score was 12 (IQR 7) preintervention and 3 (IQR 11) postintervention. Twenty-eight (70%) patients received intravenous thrombolysis. Successful recanalization (modified thrombolysis in cerebral infarction ≥ 2b) could be achieved in 85% with direct aspiration alone. Mean time from groin puncture to recanalization was 25.2 ± 14.3 minutes. Embolization to new territories occurred in 1 of 40 (2.5%) cases and symptomatic intracranial hemorrhage in 3 of 40 (7.5%). Nineteen of 40 (47.5%) patients achieved favorable outcome (modified Rankin scale 0-2) at discharge. The ADAPT technique presented as a safe and efficient first-line recanalization strategy with good clinical outcome for treatment of acute ischemic stroke resulting from large vessel occlusions in this single-center study and review of the literature. However, the concept of ADAPT as an equivalent first-line approach to stent retriever thrombectomy has to be proven by future randomized studies.

Acute Ischemic Stroke: A Review of Imaging, Patient Selection, and Management in the Endovascular Era. Part I: Initial Management and Imaging

AbstractTill recently, the mainstay of management of acute ischemic stroke (AIS) has been intravenous thrombolysis. However, response to treatment and outcomes in the presence of a large vessel occlusion (LVO) were largely suboptimal. Endovascular thrombectomy techniques with stentrievers and aspiration catheters have revolutionized stroke treatment significantly, improving outcomes in this once untreatable disease. The interventional radiologist must play an active role in the stroke team in streamlining imaging as well as endovascular management. The focus of this review article is on initial management and imaging. Initial measures consist of patient resuscitation, basic investigations and assessment of stroke severity using the National Institutes of Health Stroke Scale (NIHSS), all of which have therapeutic and prognostic implications to be considered by the neurointerventionist. Imaging must aim to be swift and efficient. Choice of a modality must be based on available infrastructure as well as clinical-radiologic factors such as the time since ictus or posterior circulation involvement. Computed tomography (CT) is the preferred modality for its speed, whereas magnetic resonance imaging (MRI) remains the gold standard problem solving technique for detection of stroke. Exclusion of hemorrhagic stroke and other stroke mimics is the first objective. Thereafter, imaging is targeted toward assessing the parenchyma and vasculature. Defining the core and penumbra is the most important goal of parenchymal imaging. The core may be defined by the presence of early ischemic changes on CT, CT angiographic source images, or diffusion restriction on MRI. The penumbra is approximated by collateral status or perfusion methods. The prime directive of vascular imaging, either CT or magnetic resonance angiography (MRA) is to establish the presence of an LVO. Once confirmed, the decision for thrombolysis and/or thrombectomy is based on clinical and imaging criteria, the most ideal being that of a moderately severe stroke with a small core and LVO on imaging.

Acute Ischemic Stroke: A Review of Imaging, Patient Selection, and Management in the Endovascular Era. Part II: Patient Selection, Endovascular Thrombectomy, and Postprocedure Management

AbstractAppropriate patient selection and expedient recanalization are the mainstay of modern management of acute ischemic stroke (AIS). Only a minority of patients (7–15%) of patients are eligible for endovascular therapy. Patient selection may be time based or perfusion based. Central to both paradigms is the selection of a patient with a small core, a significant penumbra that can be differentiated from areas of oligemia. A brief review of patient selection methods is presented. Endovascular thrombectomy techniques using stentrievers or aspiration catheters have now become the treatment of choice for AIS with large vessel occlusion. A range of devices, each with its own advantages and disadvantages, are available in the market for the neurointerventionist to choose. Techniques vary between devices and between operators, but standardization and protocolization are important within each center. Complications must be anticipated to be avoided. Once reperfusion is achieved, outcomes must be safeguarded with competent postprocedure management to prevent secondary brain injury. These aspects are reviewed in this article.

Outcomes of endovascular thrombectomy in the elderly: a ‘real-world’ multicenter study

BackgroundThe efficacy of endovascular thrombectomy (ET) for acute ischemic stroke (AIS) in octogenarians is still controversial.ObjectiveTo evaluate, using a large multicenter cohort of patients, outcomes after ET in octogenarians compared...

Outcomes of Stent Retriever versus Aspiration-First Thrombectomy in Ischemic Stroke: A Systematic Review and Meta-Analysis.

There is ongoing debate regarding the optimal first-line thrombectomy technique for large-vessel occlusion. We performed a systematic review and meta-analysis of comparative studies on stent retriever-first and aspiration-first thrombectomy. We searched Ovid MEDLINE, PubMed, and EMBASE from 2009 to February 2018. Two reviewers independently selected the studies. The primary end point was successful reperfusion (TICI 2b/3). Random-effects meta-analysis was used for analysis. Eighteen studies including 2893 patients were included. There was no significant difference in the rate of final successful reperfusion (83.9% versus 83.3%; OR = 0.87; 95% CI, 0.62%-1.27%) or good functional outcome (mRS 0-2) at 90 days (OR = 1.07; 95% CI, 0.80-1.44) between the stent-retriever thrombectomy and aspiration groups. The stent-retriever thrombectomy-first group achieved a statistically significant higher TICI 2b/3 rate after the first-line device than the aspiration-first group (74.9% versus 66.4%; OR = 1.53; 95% CI, 1.14%-2.05%) and resulted in lower use of a rescue device (19.9% versus 32.5%; OR = 0.36; 95% CI, 0.14%-0.90%). The aspiration-first approach resulted in a statistically shorter groin-to-reperfusion time (weighted mean difference, 7.15 minutes; 95% CI, 1.63-12.67 minutes). There was no difference in the number of passes, symptomatic intracerebral hemorrhage, vessel dissection or perforation, and mortality between groups. Most of the included studies were nonrandomized. There was significant heterogeneity in some of the outcome variables. Stent-retriever thrombectomy-first and aspiration-first thrombectomy were associated with comparable final reperfusion rates and functional outcome. Stent-retriever thrombectomy was superior in achieving reperfusion as a stand-alone first-line technique, with lower use of rescue devices but a longer groin-to-reperfusion time.

First-Line A Direct Aspiration First-Pass Technique vs. First-Line Stent Retriever for Acute Ischemic Stroke Therapy: A Meta-Analysis.

Background: Recent trials have proved the efficacy of mechanical thrombectomy over medical treatment for patients with acute ischemic stroke, with the balance of equivalent rates of adverse events. Stent retrievers were applied predominantly in most trials; however, the role of other thrombectomy devices has not been well validated. A direct aspiration first-pass technique (ADAPT) is proposed to be a faster thrombectomy technique than the stent retriever technique. This meta-analysis investigated and compared the efficacy and adverse events of first-line ADAPT with those of first-line stent retrievers in patients with acute ischemic stroke.Methods: A structured search was conducted comprehensively. A total of 1623 papers were found, and 4 articles were included in our meta-analysis. The Critical Appraisal Skills Programme tools were applied to evaluate the quality of studies. The primary outcome was defined as the proportion of patients with the Thrombolysis in Cerebral Ischemia (TICI) scale of 2b/3 at the end of all procedures. Secondary outcomes were the proportion of patients with functional independence (modified Rankin scale of 0–2) at the third month, the proportion of patients with the Thrombolysis in Cerebral Ischemia (TICI) scale of 2b/3 by primary chosen device, and the proportion of patients who received rescue therapies. Safety outcomes were the symptomatic intracranial hemorrhage (sICH) rate and the mortality rate within 3 months.Results: One randomized controlled trial, one prospective cohort study, and two retrospective cohort studies were included. No significant difference between these 2 strategies of management were observed in the primary outcome (TICI scale at the end of all procedures, odds ratio [OR] = 0.78), two secondary outcomes (functional independence at the third month, OR = 1.16; TICI scale by primary chosen device, OR = 1.25), and all safety outcomes (sICH rate, OR = 1.56; mortality rate, OR = 0.91). The proportion of patients who received rescue therapies was higher in the first-line ADAPT group (OR = 0.64).Conclusions: Among first-line thrombectomy devices for patients with ischemic stroke, ADAPT with the latest thrombosuction system was as efficient and safe as stent retrievers.

Endovascular Therapy Strategy for Acute Embolic Tandem Occlusion: The Pass-Thrombectomy-Protective Thrombectomy (Double PT) Technique

Embolic occlusions of the common carotid artery (CCA)/internal carotid artery (ICA) and intracranial artery occlusions in acute ischemic stroke are associated with high morbidity and can benefit from endovascular therapy. However, the optimal endovascular strategy for these conditions is unclear. This study aimed to evaluate the feasibility of the pass-thrombectomy-protective thrombectomy (double PT) technique and the clinical outcome of treated patients. We collected data on embolic occlusion of the CCA/ICA and intracranial artery occlusion in our prospective stroke registry database between January 2015 and February 2017. Clinical and angiographic data were retrospectively analyzed. Clinical outcome was evaluated at 3 months (modified Rankin scale [mRS] score), and an mRS score of 2 or lower was defined as a good clinical outcome. A total of 7 patients with tandem occlusion were included, with a mean age of 66 years. The median admission National Institutes of Health Stroke Scale score was 20, and 6 of 7 patients (85.7%) underwent successful recanalization. The median reperfusion time of the affected intracranial artery was 61 minutes. The rate of good clinical outcome was 42.9% (3/7), the mortality rate was 14.3% (1/7), and the embolic event rate was 14.3% (1/7) when the proximal clot was retrieved. The double PT technique is feasible and safe in treating initial embolic tandem occlusion of the CCA/ICA.

Combined aspiration thrombectomy and continuous intrasinus thrombolysis for cerebral venous sinus thrombosis: technical note and case series.

Cerebral venous sinus thrombosis is an uncommon cause of stroke with high morbidity and mortality rates from venous infarction, intracranial hemorrhage, and extensive cerebral edema. Endovascular treatment with various devices has been proposed as a salvage treatment when standard medical treatment with systemic anticoagulation is ineffective, especially in long segment dural sinus thrombosis. We describe our technique of transvenous endovascular aspiration thrombectomy with large bore thrombectomy catheters, followed by placement of microcatheter for local thrombolytic infusion at the site of thrombosis. We report a retrospective study of angiographic and clinical outcome of six consecutive patients treated with this approach. Endovascular aspiration thrombectomy with large bore catheters followed by continuous local thrombolytic infusion appeared to be a safe and effective salvage treatment for selected patients with cerebral dural venous sinus thrombosis refractory to medical treatment.

Larger ACE 68 aspiration catheter increases first-pass efficacy of ADAPT technique

PurposeTo report the efficacy of A Direct Aspiration first-Pass Thrombectomy (ADAPT) technique with larger-bore ACE aspiration catheters as first-line treatment for anterior circulation emergent large vessel occlusions (ELVOs), and assess...

Initial clinical experience with the ADAPT technique: A direct aspiration first pass technique for stroke thrombectomy

BackgroundThe development of new revascularization devices has improved recanalization rates and time but not clinical outcomes. We report our initial results with a new technique utilizing a direct aspiration first...

ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy

BackgroundThe development of new revascularization devices has improved recanalization rates and time, but not clinical outcomes. We report a prospectively collected clinical experience with a new technique utilizing a direct...

A Direct Aspiration First Pass Technique vs Standard Endovascular Therapy for Acute Stroke: A Systematic Review and Meta-Analysis.

The direct aspiration first pass technique (ADAPT) is a recent endovascular treatment for ischemic stroke due to large vessel occlusion that has been gaining popularity due to the rapidity of the technique and the potential for cost savings in comparison to standard thrombectomy methods such as stent retrievers. However, few studies have directly compared these 2. To compare ADAPT with stent retrievers for thrombectomy via systematic review and meta-analysis. Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ACP Journal Club, and Database of Abstracts of Review of Effectiveness limited to English through September 2016 were systematically searched. Eligible studies included those in which patient cohorts underwent ADAPT for acute stroke. Recanalization efficiency, clinical outcomes, and complication rates of ADAPT were compared with the current standard of endovascular thrombectomy techniques. Seventeen studies on ADAPT and 5 randomized controlled trials on endovascular therapy were included. ADAPT achieved higher rates of complete revascularisation (89.4% vs 71.7%, P<.001) but similar clinical outcomes compared to front-line endovascular therapy. Seventy-one point four percent of ADAPT cases were successfully recanalized with aspiration alone, and a trend towards reduced time from groin puncture to recanalization time was noted (44.77 vs 61.46 min, P=.088). The pooled results are comparable with recent randomized studies that demonstrate the benefit of endovascular therapy over intra-arterial medical therapy. Future direct comparative studies and randomized trials are required to confirm the benefit of the ADAPT strategy compared to standard endovascular therapy for acute ischemic stroke.

Revascularization Techniques for Acute Basilar Artery Occlusion : Technical Considerations and Outcome in the Setting of Severe Posterior Circulation Steno-Occlusive Disease.

To describe the clinical and radiological characteristics, frequency, technical aspects and outcome of endovascular treatment of acute basilar artery occlusion (ABO) in the setting of vertebrobasilar steno-occlusive disease. Retrospective analysis of databases of two universitary stroke centers including all consecutive patients from January 2013 until May 2017 undergoing thrombectomy for a) acute stroke due to basilar artery occlusion and either significant basilar artery stenosis or vertebral artery stenosis/occlusion as well as b) presumed embolic basilar artery occlusions. Demographics, stroke characteristics, time metrics, recanalization results and outcome were recorded. Interventional strategies were evaluated concerning the thrombectomy technique, additional angioplasty, type of approach with respect to lesion pattern (ipsilateral to steno-occlusive VA lesion: dirty road or contralateral: clean road) and sequence of actions. Out of 157 patients treated for ABO 38 (24.2%) had associated significant vertebrobasilar steno-occlusive lesions. An underlying significant basilar artery stenosis was present in 23.7% and additionally significant steno-occlusive vertebral lesions were present in 81.5%. Thrombectomy was performed with primary aspiration in 15.8% and with stent-retrievers in 84.2%. Successful revascularization (TICI 2b-3) was achieved in 86.8%. In 52.6% additional stent angioplasty was performed, in 7.9% balloon angioplasty only. The clean road approach was used in 22.5% of cases, the dirty road in 77.4%. Final modified Rankin scale (mRS) was 0-2 in 6patients (15.8%) and 3-5 in 32 (84.2%). The in-hospital mortality was 36.8%. There were no statistically significant differences in outcome compared to presumed cases of embolisms. Endovascular treatment of ABO with underlying significant vertebrobasilar steno-occlusive lesions is effective and reasonably safe. Specific procedural strategies apply depending on individual patient pathology and anatomy. Although high rates of recanalization can be achieved, outcomes tend to be poor.

V06-11 ROBOTIC RADICAL ADRENALECTOMY FOR PHEOCHROMOCYTOMA ASSOCIATED WITH ADRENAL AND RENAL VEIN TUMOR THROMBECTOMY

You have accessJournal of UrologyAdrenal, Testis, UTUC Oncology & More1 Apr 2018V06-11 ROBOTIC RADICAL ADRENALECTOMY FOR PHEOCHROMOCYTOMA ASSOCIATED WITH ADRENAL AND RENAL VEIN TUMOR THROMBECTOMY Chirag Doshi, Parth Patel, and Gopal Gupta Chirag DoshiChirag Doshi More articles by this author , Parth PatelParth Patel More articles by this author , and Gopal GuptaGopal Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1590AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Venous tumor thrombus due to an adrenal mass is rare, with published reports limited to individual cases and majority of them associated with adrenal cortical carcinoma. An adrenal and renal vein tumor thrombus due to a pheochromocytoma is exceedingly rare. To our knowledge, there have been no prior reports of a pheochromocytoma with adrenal and renal vein tumor thrombus managed robotically. Here we describe our technique of adrenal and renal vein tumor thrombectomy during a robotic left radical adrenalectomy. METHODS A 38 year-old gentleman presented with a left adrenal mass. Imaging studies revealed a left adrenal mass with left adrenal and renal vein tumor thrombus. Metabolic studies were suggestive of a pheochromocytoma. He was taken to the operating room for a robotic left radical adrenalectomy with renal vein tumor thrombectomy. Intraoperative ultrasound was used to delineate the extent of tumor thrombus into the left renal vein. The left renal artery, proximal and distal aspect of left renal vein and left gonadal vein were briefly controlled with vascular clamps. The adrenal vein was incised close to the renal vein and the tumor thrombus was removed en bloc with the left radical adrenalectomy specimen. The venotomy was repaired using 4-0 Prolene and the kidney was revascularized. RESULTS Renal warm ischemia time was 26 minutes, estimated blood loss was 800cc, operative time was 4.4 hours. Pathology revealed a 6.5cm pheochromocytoma with vein tumor thrombus. Surgical and vein margins were negative. Intra-operatively there were no uncontrolled or sustained hypertensive episodes. CONCLUSIONS Robotic assisted radical adrenalectomy is a feasible option for patients with associated adrenal or renal vein tumor thrombus without compromising oncologic outcome. Fundamental technical steps include use of intraoperative ultrasound, renal vascular control and renal venotomy repair. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e664 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Chirag Doshi More articles by this author Parth Patel More articles by this author Gopal Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Efficacy of Mechanical Thrombectomy Using Stent Retriever and Balloon-Guiding Catheter.

Intra-arterial therapy of acute ischemic stroke has developed rapidly in recent years. Due to proven efficacy in randomized trials, stent retrievers were replacing first-generation thrombectomy devices and have been defined as method of choice. However, aspiration catheters or a combination of several techniques have shown promising rates of successful recanalizations. To create a basis for comparison of the new approaches according to real-world data, we determined the first pass recanalization rate of an evidence-based standard technique with the use of a stent retriever in combination with a balloon-guiding catheter. The assessment was based on the number of required passages and reperfusion rate, but not on clinical results. Patients from our institution with anterior circulation occlusions and mechanical thrombectomy by using stent retrievers in combination with balloon-guiding catheters were analyzed retrospectively. Reperfusion was graded with the "thrombolysis in cerebral infarction" (TICI) classification on post-interventional angiograms. Additionally, the number of passes and the duration of the recanalization procedure were recorded. Between 2014 and July 2017, 201 patients met the inclusion criteria. Successful recanalization, defined as a TICI scale 2b/3, was 91% (TICI 2b was achieved in 44% and TICI 3 in 47%) after the procedure. After the first passage, successful recanalization was achieved in 65% of the patients. Mean number of passes was 1.4 (1-5 passes) for all patients. Median duration of the procedure was 49min (0:11-2:35h). Even a standard thrombectomy technique with the use of a stent retriever together with a balloon-guiding catheter provides reasonable recanalization rates with only one passage. The results can be taken as benchmark for alternative and more complex techniques.

Abstract 56: Frequency, Determinants, and Outcomes of Distal Emboli Related to Mechanical Thrombectomy for Acute Ischemic Stroke

Introduction: Clot fragmentation and distal embolization is a feared complication of mechanical thrombectomy treatment for acute ischemic stroke, but the frequency, determinants, and outcomes of distal emboli (DE) with modern endovascular reperfusion techniques is poorly characterized. Gradient refocused echo (GRE) MRI, performed before and after intervention, is a novel technique to directly visualize distal emboli and characterize their causes and consequences. Methods: We analyzed consecutive acute ischemic stroke thrombectomy patients who had MR imaging pre- and post-intervention. Distal emboli were defined as new post-procedure susceptibility vessel signs on GRE, within arteries distal to the target occlusion or within new territories. Results: Among 50 consecutive patients, age was 70.4 (±15.8), 44% were female, and NIHSS was 15 (IQR 8-19). Thrombectomy techniques include retrievers alone in 42%, aspiration alone in 8%, both retriever and aspiration in 50%, and other (e.g. angioplasty, wire maceration) in 22%. The rate of substantial reperfusion (mTICI 2b-3) was 84%. New distal emboli downstream in the territory of the target occlusion were noted in 22% of patients (single in 91% and multiple in 9%), while no emboli in a new territory were observed. Predictors of distal emboli were: pretreatment with IV tPA (present in 64% of patients with DE vs 26% without, p=0.03); and ICA target occlusion location (64% vs 28%, p=0.04). Nominal differences in the 3-month rate of severely disabled or dead outcome (mRS 5-6) did not reach statistical significance (44% vs 24%, p=0.40). Conclusions: In the modern neurothrombectomy era, distal emboli within the territory of the target occlusion occur in more than 1 in 5 patients, but embolization to new territories is very uncommon. Predictors of distal emboli are prior intravenous thrombolytic therapy (increasing clot friability) and ICA occlusion location (requiring manipulation of larger thrombi).

Нирково-клітинний рак, ускладнений тромбозом нижньої порожнистої вени та правого передсердя

Aim.&nbsp;To analyze the contemporary views of the relevance, features of classification, clinical course, diagnosis and treatment of renal cell carcinoma, complicated by thrombosis of the inferior vena cava and the right atrium. Material and Methods.&nbsp;The publications on the topic over the period of 2004-2017 were analyzed. Fifty-seven primary sources were selected, reflecting the relevance, features of classification, clinical course, diagnosis and treatment of renal cell carcinoma, complicated by thrombosis of the inferior vena cava and the right atrium. Results and Discussion.&nbsp;A specific feature of renal cell carcinoma is the predisposition to vascular invasion with the formation of tumorous thrombi &nbsp;in the renal vein and inferior vena cava in 4-10% of cases, sometimes &nbsp;spreading to the right atrium. Frequency of 5-year survival of patients with renal cell carcinoma, complicated with venous invasion, at the absence of distant metastases, is 40-69%, while the intravenous spreading is not considered a criterion for dissemination of the tumorous process in the postoperative period. Therefore, radical nephrectomy with caval thrombectomy remains the method of choice in treating such patients . Despite the improvements in the techniques of caval thrombectomy, surgical treatment continues to be technically difficult, associated with a high incidence of complications and mortality, especially in the removal of tumorous thrombi of the retrohepatic and supradiaphragmatic parts of the inferior vena cava and the right atrium. Extremely important for the safe removal of the tumorous thrombi is the preoperative assessment of the prevalence of neoprocesses, the presence of venous wall invasion, of hepatic veins (Budd-Chiari syndrome), as well as optimal prevention of thromboembolic and hemorrhagic complications. Conclusions.&nbsp;Radical surgery remains the method of choice in the treatment of renal cell carcinoma complicated with thrombosis of the inferior vena cava and the right atrium. The analysis of literary sources revealed evidence of the high efficiency of radical nephrectomy in combination with caval thrombectomy, which is conditioned by timely diagnosis of the neoprocess spreading, improvement of of surgical treatment strategy, and optimal prevention of severe hemorrhagic and thromboembolic complications, which would provide satisfactory long-term results.