Mechanical thrombectomy: Procedure for stroke treatment
A mechanical thrombectomy is a minimally invasive technique where a clot in a patient’s artery is removed by an interventional radiologist or endovascular neurosurgeon using specialised equipment.
INDICATIONS
Arterial obstructions caused by blood clots are treated using this method. A mechanical thrombectomy can treat the following conditions:
A blood clot that develops in a vein is known as deep vein thrombosis (DVT). Although they can happen in the arms as well, DVTs most frequently arise in the legs. Vein valves may sustain irreversible damage as a result of deep vein thrombosis (DVT). Leg sores, discomfort, and swelling are some of the long-term issues that may result from this. Another risk associated with DVTs is the potential for the clot to separate and travel to the lungs. If this happens, the clot may ultimately obstruct blood flow and result in a potentially lethal pulmonary embolism.
An ischaemic stroke occurs when a blood clot forms in an artery that supplies blood to the brain or in another part of the body and is swept to a brain artery. As a result, the brain’s blood flow slows or stops. Permanent brain injury can occur in a matter of minutes. Retrieving the ischaemic penumbra is the main goal of mechanical thrombectomy in cases of ischaemic cerebral stroke. Recent research has demonstrated the effectiveness of mechanical thrombectomy and its superiority over intravenous (IV) thrombolytics, resulting in a significant expansion of its indications. The following standards for endovascular mechanical thrombectomy therapy are suggested by the American Heart Association/American Stroke Association guidelines for the early management of acute ischaemic stroke:
- NIH stroke scale score ≥ 6; Alberta stroke program early CT score ≥ 6; pre-stroke modified Rankin scale
- Procedure commencement within six hours of the start of symptoms
- Acute blockage of the proximal middle cerebral artery (M1) or the internal carotid artery
- 18 years of age or older
In certain patients with large vascular ischaemic stroke who presented up to 24 hours after the onset of symptoms, studies showed that mechanical thrombectomy improved clinical outcomes when compared to standard therapy alone. The time frame for thrombectomy has been extended to 24 hours following the start of symptoms according to current indications.
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CONTRAINDICATIONS
- Brain Haemorrhage
- A large infarct core
- Occlusion of small vessels
- Coagulopathies that are incurable
- Excessive blood pressure that is uncorrectable (systolic >185 mmHg or diastolic >110 mmHg)
PROCEDURE
- A tiny incision is made in your wrist or groin by an endovascular specialist.
- A catheter is inserted via an artery that supplies your brain and neck using real-time X-ray-guided imaging.
- Experts advance the catheter past the blood clot after inserting a device (stent retriever) into it.
- In order to grasp the clot and stretch the arterial walls, the device expands.
- After that, removal of the stent via the incision and back through the artery with the clot is done.
According to studies, individuals who undergo a mechanical thrombectomy recover more quickly and have a higher quality of life than those who just use tissue plasminogen activators, also known as clot-busting tPAs. Treatment for blood clots must be prompt and efficient because they are a significant medical problem.
However, not everyone is a good candidate for mechanical thrombectomies, as is the case with many surgical operations. In an emergency, be aware that a mechanical thrombectomy is a viable alternative if a tPA is insufficient to treat a clot.
