Methods and systems for treatment of acute ischemic stroke
Methods and devices are disclosed that enable safe, rapid and relatively short and straight access to the cerebral arteries for the introduction of interventional devices to treat acute ischemic stroke. In addition, the disclosed methods and devices provide means to securely close the access site to the cerebral arteries to avoid the potentially devastating consequences of a transcervical hematoma.
1. A method for accessing an intracranial artery pursuant to a procedure to treat acute ischemic stroke, comprising:
forming a penetration in a wall of a common carotid artery or internal carotid artery;
applying a closure device at a very beginning of the procedure at a site of the penetration and before placement of any structure through the penetration including an arterial access sheath, the closure device having sutures;
positioning an arterial access sheath having an occlusion element and an inner diameter that is between 7 Fr and 10 Fr through the penetration such that the occlusion element is positioned within the internal carotid artery;
occluding the internal carotid artery;
establishing retrograde blood flow through the internal carotid artery distal of the occluding element;
inserting a distal catheter having an aspiration lumen into the intracranial artery through the access sheath, the distal catheter further having a distal-most end that defines an opening into the aspiration lumen
treating a thrombotic blockage in the intracranial artery by positioning the distal-most end of the distal catheter so that the distal-most end is located immediately adjacent the thrombotic blockage in the intracranial artery;
aspirating blood and/or material from the thrombotic blockage in the intracranial artery into the opening at the distal-most end of the distal catheter such that the aspiration causes the blood and/or material from the thrombotic blockage to flow into the opening at the distal-most end of the distal catheter;
removing the arterial access sheath from the penetration; and
closing the access site with the sutures of the closure device.
2. A method as in claim 1 , wherein establishing retrograde blood flow through the internal carotid artery comprises causing blood to flow into a lumen of the arterial access sheath and into a shunt connected to the access sheath.
3. A method as in claim 2 , further comprising regulating the retrograde blood flow.
4. A method as in claim 2 , further comprising controlling a state of the retrograde blood flow.
5. A method as in claim 2 , further comprising monitoring the retrograde blood flow.
6. A method as in claim 1 , wherein treating a thrombotic blockage further comprises inserting a treatment device through the arterial access sheath and positioning at least a portion of the treatment device in the intracranial artery for the purpose of at least removing or disrupting the thrombotic blockage.
7. A method as in claim 6 , wherein removing the thrombotic blockage further comprises aspirating the thrombotic blockage or debris generated from the thrombotic blockage.
8. A method as in claim 1 , wherein treating a thrombotic blockage further comprises establishing a lumen through the thrombotic blockage.
9. A method as in claim 8 , wherein establishing a lumen comprises implanting a temporary or permanent stent in the thrombotic blockage.
10. A method as in claim 1 , wherein treating a thrombotic blockage further comprises infusing a bolus of thrombolytic drug through the arterial access sheath to the thrombotic blockage in the intracranial artery.
11. A method as in claim 1 , wherein the occlusion element is a balloon.