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 of treating a patient, the method comprising:
forming an opening through a wall of a common carotid artery;
inserting through the opening an arterial access sheath having an inner diameter that is between 7 Fr and 10 Fr configured to be inserted directly into the common carotid artery;
positioning a distal end of the arterial access sheath within an internal carotid artery proximal of a thrombotic blockage in a cerebral artery of a brain;
occluding the internal carotid artery to establish retrograde blood flow through the internal carotid artery;
providing access to the cerebral artery via an internal lumen of the arterial access sheath;
delivering a perfusion catheter through the arterial access sheath into the thrombotic blockage while occluding the internal carotid artery, the perfusion catheter adapted to deliver a perfusion solution to a target location in the brain of the patient; and
perfusing hypothermic perfusion solution through the perfusion catheter to cool brain tissue in the target location in the brain.
2. The method of claim 1 , wherein the perfusion solution comprises autologous arterial blood, an oxygenated solution, or a neuroprotective agent.
3. The method of claim 1 , further comprising treating the thrombotic blockage in the cerebral artery of the brain.
4. The method of claim 3 , wherein treating the thrombotic blockage comprises performing aspiration thrombectomy or mechanical thrombectomy in the cerebral artery near the target location.
5. The method of claim 3 , wherein treating the thrombotic blockage comprises inserting a treatment device through the arterial access sheath and positioning at least a portion of the treatment device in the cerebral artery for the purpose of at least removing or disrupting the thrombotic blockage.
6. The method of claim 5 , wherein removing the thrombotic blockage further comprises aspirating the thrombotic blockage or debris generated from the thrombotic blockage.
7. The method of claim 3 , wherein treating the thrombotic blockage further comprises establishing a lumen through the thrombotic blockage, and wherein establishing a lumen comprises implanting a temporary or permanent stent in the thrombotic blockage.
8. The method of claim 3 , wherein treating the thrombotic blockage further comprises infusing a bolus of thrombolytic drug through the arterial access sheath to the thrombotic blockage in the cerebral artery.
9. The method of claim 1 , wherein forming an opening comprises creating an incision or a puncture.
10. The method of claim 1 , further comprising applying a closure device.
11. The method of claim 10 , further comprising removing the arterial access sheath from the opening.
12. The method of claim 11 , wherein the closure device is deployed as the arterial access sheath is being removed from the opening.
13. The method of claim 11 , wherein the closure device is deployed before the arterial access sheath is removed from the opening.
14. The method of claim 11 , wherein the closure device is a self-closing closure device.
15. The method of claim 14 , wherein the self-closing closure device exerts frictional force on the access sheath during the method to reduce dislodgement of the sheath from the opening.
16. The method of claim 11 , wherein the closure device comprises an anchor portion and a closing portion.
17. The method of claim 16 , wherein the anchor portion is selected from the group consisting of hooks, pins, staples, clips, tines, and sutures.
18. The method of claim 16 , wherein the closing portion is self-closing.
19. The method of claim 16 , wherein the closing portion is suture-based.
20. The method of claim 19 , wherein the suture-based closing portion is configured to place one or more sutures across the opening such that ends of the one or more sutures are tied off to provide hemostasis after the access sheath is removed.
21. The method of claim 20 , wherein the one or more sutures are placed across the opening prior to insertion of the access sheath through the opening or after removal of the access sheath from the opening.
22. The method of claim 21 , wherein the one or more sutures maintain temporary hemostasis after removal of the access sheath before tying off the ends.
23. The method of claim 10 , wherein the closure device is applied upon commencement of the method at a site of the opening and before placement of any structure through the opening.
24. The method of claim 1 , wherein occluding the internal carotid artery comprises expanding an occlusion element on the arterial access sheath to occlude the internal carotid artery with the arterial access sheath.