Endovascular clot retrieval for ischemic or acute stroke

Center : Neurology Center

Article by : Dr. Chanwit Ankrohwittaya

Endovascular clot retrieval for ischemic or acute stroke

Patients with ischemic or acute stroke, if they arrive at the hospital within the first 4.5 hours, can be treated with emergency IV injection to dissolve blood clots which reduces disability and the risk of dying. Patients who arrive at the hospital so late that they cannot be treated with emergency IV injection, Endovascular Clot Retrieval or Mechanical Thrombectomy is the innovative treatment that can save lives.


Endovascular Clot Retrieval or Mechanical Thrombectomy

This is a treatment for ischemic or acute strokes by inserting a catheter through the aorta with a coil in the groin to the site of the blockage. Then, remove the clogged blood clot from the cerebral artery to open the vascular hole without major surgery. This will allow blood to flow to the ischemic part of the brain again which makes the brain recover and returned to be better. For patients with large blood clot cannot be treated with emergency IV injection or not arriving in time 4.5 hours,

Mechanical Thrombectomy can extend the treatment time up to 6 hours after symptoms appear, or up to 24 hours in some patients considered by the doctor to be successful.

Mechanical Thrombectomy in patients with ischemic or acute strokes is considered a highly effective treatment up to 80% of opening clogged arteries, reducing post-treatment complications, reducing the chance of paralysis. Patients will have a good response to treatment and symptoms improve to the normal.


When to use Mechanical Thrombectomy

Patient who arrives at the hospital later than emergency IV injection period, which is 4.5 hours, and is examined by Computed Tomography (CT scan) or Magnetic Resonance Imaging (MRI) found to have a large blood clot, patient is still within the range that can be treated with this procedure.

Patients treated with emergency IV injection but does not work or have abnormal symptoms, the doctor considered that a Mechanical Thrombectomy procedure could be used to retrieve a blood clot. Including the patient has some contraindications to the emergency IV injection to dissolve blood clots or have an abnormal blood clotting condition.


The procedure for Mechanical Thrombectomy

  1. The patient must be given anesthesia.
  2. Clean the skin around the groin.
  3. Cut the skin around the groin. It is a small incision about 3-4 mm for inserting a catheter.
  4. Doctor will insert a catheter through the aorta at the groin to site of the blockage in the cerebral artery by using x-ray navigation indicating the position.
  5. Doctor will place a small special stent through the catheter up to the location of the blood clot. Then, slowly release the coil to spread out to catch the blood clots, and then slowly bring it out through the catheter.
  6. Pull the catheter out of the patient's body through the groin.
  7. Once the clot, stent, and catheter are removed from the patient; the nurse will press to stop bleeding at the groin for about 10-15 minutes. The patient must lie down on the bed. Do not bend the catheter-injected leg for 8-12 hours (at the discretion of the doctor.
  8. Patient must stay in the Intensive Care Unit to observe symptoms. Medical team will monitor for any changes in the brain or brain hemorrhage. Monitoring vital signs closely 24 hours. If assessed that the patient is safe, the doctor will then be allowed to move to a normal ward.
After the treatment, the patient will undergo rehabilitation of the body and nervous system through physical therapy to be able to return to life as close to normal as possible. The results will differ depending on each patient.




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