Begin with an acute ischemic stroke patient with a large vessel occlusion in their brain.
Sedate the patient and place a sterile drape to prepare for endovascular treatment or EVT.
Shave and disinfect the patient's groin area.
Use the stent retriever-assisted vacuum-locked extraction or SAVE technique for EVT.
To perform SAVE, expose the femoral artery, a large blood vessel in the thigh, and puncture it using a needle.
Introduce a guiding sheath through the femoral artery to reach the brain blood vessel containing the clot.
Then, insert a catheter containing a stent retriever.
As the catheter is pulled out, the stent opens up, securing the clot.
The stent with the clot is then extracted with the help of suction from a vacuum pump.
Perform an angiogram to confirm successful reperfusion of the blood vessel.
Prepare the patient for the EVT together with the neuroradiological technician. Have the neuroradiological technician set up the material required for the EVT. Shave and disinfect the patient's groin with skin antiseptic, and place sterile drapes to ensure aseptic conditions for the EVT.
Induce sedation with ketamine in combination with propofol intravenously, and maintain a continuous infusion of propofol to ensure sufficient spontaneous breathing and patient cooperation. If conscious sedation seems inappropriate due to sustained agitation or movement of the patient, intubate the patient so that EVT is performed under general anesthesia. To perform the EVT, puncture the right femoral artery in the groin using an 18-gauge puncture needle, and introduce a peripheral 8F guiding sheath. Then start the EVT.
The total target time from patient admission to groin puncture is 30 minutes. Confirm successful reperfusion, which is defined as a modified thrombolysis in cerebral infarction score of 2B to 3 from control angiogram. Then perform a flat panel detector and geographic CT. Read the images to rule out complications of the treatment, such as intracranial hemorrhage.
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