METHOD OF X-RAY ENDOVASCULAR COMBINED THROMBECTOMY FROM ARTERIES OF BRAIN Russian patent published in 2018 - IPC A61M25/01 A61M25/10 A61B17/00 A61F2/01 

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, in particular to vascular surgery and neuroradiology. Puncture of the femoral or radial artery is performed and the corresponding extracranial artery is catheterized as an access vessel. With the help of a conductor, a balloon guided catheter is inserted with the installation of its distal part in the extracranial section of the access vessel. Aspiration catheter is inserted into the balloon guide catheter, and the last one is a microcatheter, forming a coaxial system "balloon guide catheter – aspiration catheter – microcatheter". Conduct microconductor in microcatheter, bring it to the occlusion zone, delivering a microcatheter to it, a microcatheter to the occlusion bring the aspiration catheter. Perform penetration of occlusion with a microconductor and/or a microcatheter and conduct a microcatheter beyond the occlusion zone. After removal of the microconductor into the occlusion zone, the stent retriever is delivered and expanded through the microcatheter lumen. Microcatheter is removed and performed by temporary balloon occlusion of the guide catheter. Perform aspiration from the lumen of the aspiration catheter with simultaneous traction of the stent retreat into it. If the stent-retractor tract is difficult to penetrate into the lumen of the aspiration catheter and / or when the aspiration flow decreases markedly, the whole aspiration catheter complex with retrograde stent and thromboemboli are removed, with additional aspiration from the lumen of the guide catheter. When the complex has completed half the length of the guide catheter, aspiration is stopped from the guide catheter and the complex is completely removed from the guide catheter. Then, the temporary occlusion of the access vessel is terminated, after aspiration, 10 ml of blood from the guide catheter is performed by control angiography. In another embodiment, a femoral or radial artery puncture is performed and the corresponding extracranial artery is catheterized as an access vessel. With the help of a conductor, a balloon guided catheter is inserted with the installation of its distal part in the extracranial section of the access vessel. Aspiration catheter is inserted into the balloon guide catheter, and the last one is a microcatheter, forming a coaxial system "balloon guide catheter – aspiration catheter – microcatheter". Conduct a microconductor into the microcatheter, bring it to the occlusion zone, delivering a microcatheter to it. If it is not possible to immediately deliver the aspiration catheter to the occlusion, the occlusion penetration is performed by the microconductor and/or microcatheter and the microcatheter is carried out beyond the occlusion zone. After removing the microconductor through the lumen of the microcatheter into the occlusion zone, a stent-retreatment is performed and spread it. On the microcatheter, an aspiration catheter is delivered to the occlusion zone. Microcatheter is then removed. Perform a temporary occlusion balloon guide catheter. Perform aspiration from the lumen of the aspiration catheter with simultaneous traction of the stent retreat into it. If the stent-retractor tract is difficult to penetrate into the lumen of the aspiration catheter and / or when the aspiration flow decreases markedly, the whole aspiration catheter complex with retrograde stent and thromboemboli are removed, with additional aspiration from the lumen of the guide catheter. When the complex has completed half the length of the guide catheter, aspiration is stopped from the guide catheter and the complex is completely removed from the guide catheter. Temporary occlusion of the access vessel is terminated, after aspiration, 10 ml of blood from the guide catheter is performed by control angiography. Next variant: puncture the femoral or radial artery and catheterize the corresponding extracranial artery as an access vessel. With the help of a conductor, a balloon guided catheter is inserted with the installation of its distal part in the extracranial section of the access vessel. Aspiration catheter is inserted into the balloon guide catheter, and the last one is a microcatheter, forming a coaxial system "balloon guide catheter – aspiration catheter – microcatheter". Conduct a microconductor into the microcatheter, bring it to the occlusion zone, delivering a microcatheter to it. If it is not possible to deliver the aspiration catheter to the occlusion site, occlusion penetration is performed with a microconductor and/or a microcatheter and a microcatheter is conducted beyond the occlusion zone. After removing the microconductor through the lumen of the microcatheter into the occlusion zone, a stent-retreatment is performed and spread it. Microcatheter is then removed. Perform a temporary occlusion balloon guide catheter. Begin the antegrade advancing of the aspiration catheter to the stent-retriever and immediately after aspiration half way aspiration starts from the lumen of the aspiration catheter. When the stent retriever reaches the aspiration catheter, the latter is fixed in place. Perform aspiration from the lumen of the aspiration catheter with simultaneous traction of the stent retreat into it. If the stent-retractor tract is difficult to penetrate into the lumen of the aspiration catheter and when the aspiration flow decreases markedly, the whole "aspirated catheter-stent-retreatment-thromboembolus" complex begins to be removed with additional aspiration from the lumen of the guide catheter. When the complex has completed half the length of the guide catheter, aspiration is stopped from the guide catheter and the complex is completely removed from the guide catheter. Temporary occlusion of the access vessel is terminated, after aspiration, 10 ml of blood from the guide catheter is performed by control angiography.

EFFECT: group of inventions allows to prevent or reduce the risk of distal embolization and embolization of the proximal branches of the cerebral arteries with a minimum number of thrombectomies, it reduces the time of operation, reduces the consumption of contrast medium and radiation and does not allow the spread of a stroke.

3 cl, 35 dwg, 3 ex