Improving Treatment of Stroke: Guiding Endovascular Mechanical Thrombectomy

摘要：在过去的几年里，缺血性中风的治疗发生了一场革命。血栓 溶解药物对许多患者有帮助，但当大脑大动脉被阻塞时，效果有限。 最近有研究表明，通过导管物理清除血栓在以下方面非常有效 减少对大脑的损害。血栓清除可在发病后24小时内有效。 症状。 最有效的取栓方法是将血栓与支架一样的取回器接合 并使用取回器将血栓拉回导管中。移除 这种方法的血栓是在取回血栓的过程中不能直接看到血栓。这个 支架被拉回时可能会留下血栓，或者血栓碎片可能会断裂并滞留。 在他们无法到达的下游。血栓本身在x射线图像中是看不到的，所以没有 通过支架取回器，我们可以知道血栓的移动有多彻底。 我们建议开发独特的磁性纳米技术来监测这些物质的机械提取 血栓形成。血栓将被覆盖有磁性纳米颗粒和来自这些纳米颗粒的信号 将用于监测血栓相对于支架取回器的位置。使用支架取回器本身 作为天线，人们可以测量附近结合在血栓内的磁性纳米颗粒的信号。我们会 证明如果血栓相对于支架取回器移动，或者如果血栓相对于支架取回器移动，信号会发生显著变化 碎片会使血栓破裂。我们还将演示可以产生血栓的图像 在血栓清除过程中。这些工具将使医生能够更一致地减少手术时间 清除整个血栓，我们预计这将改善患者的预后。

Abstract: In the last few years there has been a revolution in the treatment of ischemic stroke. Thrombus dissolving drugs help many patients but have limited effectiveness when the large cerebral arteries are blocked. It has recently been shown that physically removing the thrombus through a catheter is remarkably effective at reducing the damage to the brain. Removing the thrombus can be effective up to 24 hours after the onset of symptoms. The retrieval method that is most consistently effective is to engage the thrombus with a stent-like retriever and use the retriever to pull the thrombus back into a catheter. One of the challenging aspects of removing the thrombus with this method is that the thrombus cannot be directly visualized during the process of retrieval. The thrombus can be left behind as the stent is pulled back, or fragments of the thrombus can break off and lodge downstream where they cannot be reached. The thrombus itself cannot be seen in x-ray images so there is no way to know how completely the thrombus is being moved with the stent-retriever. We propose to develop unique magnetic nanotechnology to monitor mechanical extraction of these thromboses. The thrombus will be coated with magnetic nanoparticles and the signal from those nanoparticles will be used to monitor the position of the thrombus relative to the stent-retriever. Using the stent-retriever itself as an antenna, one can measure signal from nearby magnetic nanoparticles bound within the thrombus. We will demonstrate that the signal changes dramatically if the thrombus moves relative to the stent-retriever or if a fragment breaks off the thrombus. We will also demonstrate that it is possible to produce images of the thrombus during thrombus removal. These tools will enable the physician to reduce procedure time, more consistently remove the entire thrombus which we expect will improve patient outcomes.