ABSTRACT
If satisfactory backbleeding is not obtained with the method previously described for thrombus removal with a shunt tubing on a blunt needle, a Fogarty catheter can be used instead. The problem with Fogarty catheters involves documented reports of the creation of a carotid cavernous fistula by inflating the balloon in the cavernous carotid artery. Nonetheless, if there is no other technique available to reestablish backbleeding, a Fogarty catheter is a useful choice. As shown in the illustration, it is advanced up into the region of thrombus. The balloon is then inflated and the catheter is withdrawn, pulling thrombus with it. It may be necessary to repeat this step several times before adequate backbleeding is obtained. It should be emphasized that copious backbleeding rather than a mere trickle should be the endpoint with either method and in the absence of significant backbleeding, it may be wiser to perform a stump ligation and closure of the ICA rather than settling for reestablishment of flow with an upstream thrombus that will then be catapulted up into the intracranial circulation.
