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    15 April 2005

    Learning from ER: embolectomy for stroke

    Last night on ER: Season 11 Episode 15: Alone in a Crowd
    A young mother of three (Cynthia Nixon of Sex in the City) is brought in with symptoms of a potentially fatal stroke .....

    Its too late for thrombolysis but the interventional radiologist carries out an embolectomy using a new technique ...

    I'd not heard of this one before, so I turned to Google.
    Here's the result of one Google search.

    Thrombolysis nust be initiated within three hours of onset of an acute stroke, but embolectomy with the Merci retrieval system is effective up to 8 hours after onset of stroke symptoms.

    A description of the technique can be found here.
    For a video, click here.
    The vendor's site is here.


    Mechanical thrombectomy of the internal carotid artery and middle cerebral arteries for acute stroke by using the retriever device.
    Martinez H, Zoarski GH, Obuchowski AM, Stallmayer MJ, Papangelou A, Airan-Javia S
    AJNR Am J Neuroradiol. 2004 Nov-Dec;25(10):1812-5

    MERCI 1: a phase 1 study of Mechanical Embolus Removal in Cerebral Ischemia.
    Gobin YP, Starkman S, Duckwiler GR, Grobelny T, Kidwell CS, Jahan R, Pile-Spellman J, Segal A, Vinuela F, Saver JL.
    Stroke. 2004 Dec;35(12):2848-54. Epub 2004 Oct 28

    And a case report published in 2000 claiming to be 'the first reported use of a snare to remove clot in the setting of thromboembolic stroke'
    Transcatheter snare removal of acute middle cerebral artery thromboembolism: technical case report.
    Chopko BW, Kerber C, Wong W, Georgy B.
    Neurosurgery. 2000 Jun;46(6):1529-31

    Other things I've learnt from ER:

    Different ways of holding and positioning a Sonosite portable ultrasound machine.

    How to rule out a mandibular fracture and avoid doing an x-ray (get the patient to bite a tongue depressor, then twang it; if it doesn't hurt, there's no fracture).

    I'll be submitting my ER viewing for CME credits.

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