Trans-Clot MAP gradient: A novel innovative technique during thrombectomy for acute ischemic stroke with potential applications for assessing collateral circulation, determining clot etiology, informing device selection, and predicting first-pass success.
Amit Chaudhari, Mohammad Al Majali, Eugene I Lin et al.
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Case in brief
Two patients with acute ischemic stroke had a left M1 near-complete occlusion and a left P1 occlusion, respectively. After intravenous tenecteplase, both underwent emergent thrombectomy with intraoperative trans-clot manometry. The measured trans-clot mean arterial pressure gradients were 66.7% and 96.9%. Each patient achieved TICI 3 reperfusion on the first pass, with NIHSS scores improving from 11 to 1 and from 19 to 8. The report presents manometry as a way to quantify collateral blood flow during thrombectomy; its clinical utility and proposed applications require further validation.
What made this case unusual
The report describes intraoperative measurement of a trans-clot MAP gradient as a quantitative indicator of collateral flow, with measurements obtained in occlusions at different locations and vessel sizes.
Diagnostic / clinical pearl
Trans-clot manometry may provide an objective intraoperative measure of collateral flow, but these two cases do not establish gradient thresholds or validate its use to select devices or predict first-pass success.