When a person suffers from an ischemic stroke, there has been a blockage of a blood vessel in the brain that is preventing blood from flowing as it should. When blood can’t get to an area of the body, that means oxygen is not being delivered. The longer the area is starved of oxygen, the greater the potential for permanent damage.
If you or someone you know has had an acute ischemic stroke, you may have heard of a medical treatment that has come to the forefront in clinical trials and medical practice: mechanical thrombectomy for acute ischemic stroke. When combined with drug therapy, mechanical thrombectomy is proving to be a very effective treatment for resolving blockages and restoring blood flow to the brain.
The Reasoning
A thrombectomy means to remove a thrombus, or clot, from a blood vessel. During a stroke, a blood vessel in the brain is blocked and impeding blood flow. The clot is typically a piece of a clot that broke off from somewhere else in the body and traveled to the brain, where it became lodged within a vessel. If blood is not reaching the brain, it is deprived of oxygen, or ischemic, and at risk for severe damage. This brain damage is what causes the long-term effects seen after a stroke, such as difficulty speaking, partial paralysis and impaired mobility, depending upon the area of the brain experiencing ischemia and the extent to which it was damaged.
In order to reduce the risk of permanent brain injury, a stroke surgeon needs to remove the blockage as soon as possible and return the brain’s oxygen supply to normal levels. In the past, doctors relied on drugs alone to resolve clots, with limited success. However, multiple studies have shown that a combination of drug treatment and mechanical thrombectomy can reduce the risk of long-term disability following an acute ischemic stroke. In fact, the American Heart Association (AHA) and American Stroke Association (ASA) now recommend tissue plasminogen activator treatment in combination with mechanical thrombectomy in eligible patients.
The Procedure
When a stroke surgeon performs a mechanical thrombectomy, they go into the blood vessel with the clot and physically removes the blockage. This could be done in a couple of different ways, but the most common is to use a device called a stent retriever. The surgery itself is relatively straightforward except that it has to been done very fast, usually within six hours of when the stroke symptoms began. The doctor makes an incision in your thigh, then carefully guides a catheter through your arteries using advanced imaging technology to reach the thrombus forming the blockage in the brain.
Once the stroke surgeon reaches the clot site with the catheter, then he or she needs to break up the blockage. Your doctor will probably use a stent retriever, which looks like a small mesh cage at the end of a flexible stick. The surgeon pushes the stent retriever to the clot site through the catheter and positions it so the clot is physically trapped within the cage. Then, the stroke surgeon reverses the procedure and removes both the stent retriever and clot, immediately restoring blood flow.
The Advantages
The use of mechanical thrombectomy in acute ischemic stroke is recommended by the AHA and ASA with good reason. Not only do clinical trials show improved mobility and quality of life post-treatment, but because the procedure itself is relatively simple, recovery from the thrombectomy is fairly quick. The surgical site is a small incision in the upper thigh and provides surgeons with a far less invasive way of accessing the clot location.
That being said, recovery from the stroke itself depends upon the individual patient and how quickly the surgeon performs the procedure after a stroke occurs. Ideally, mechanical thrombectomy is performed within six hours of ischemic stroke. The less time the brain spends in an ischemic state, the less time there is for potential damage to occur. There may even be noticeable improvement immediately upon removal of the thrombus and restoration of blood flow.
Actual time spent in the hospital post-treatment will be based upon your particular situation. There will likely be a period of observation and rehabilitation, depending upon the effects of the stroke itself. However, surgical recovery itself is generally quick and straightforward.
The Decision
Whether making the decision for yourself or a loved one, choosing to have a mechanical thrombectomy for acute ischemic stroke can be a life-saving procedure and has been demonstrated in multiple studies to reduce rehabilitation time and result in improved quality of life. Not every stroke patient is a good candidate for mechanical thrombectomy, so you may wish to request an emergent consult with a stroke neurosurgeon regarding you or your loved one’s particular case.
That being said, a stroke is a medical emergency. If you or a loved one has experienced symptoms of a stroke, seek emergency medical treatment immediately, even if the symptoms appear to have resolved on their own. Early intervention can improve outcomes and even prevent death, so call 911 right away at any sign of a stroke.
