What is Mechanical Thrombectomy?

What is mechanical thrombectomy ?

It is an emergent minimally invasive surgery in which a catheter is introduced into the artery in the groin (femoral artery) in order to access the artery in the brain which has been blocked by a clot. We utilize contrast or “dye” through the catheter to identify the exact location of the blood clot. Then, with help of specialized devices called stent retrievers we can remove the blood clot allowing us to open up the artery reestablish blood flow.

Do all ischemic strokes require treatment with mechanical thrombectomy?

Not all ischemic strokes require the procedure. If the stroke is due to large blood vessel occlusion (LVO), then IV tPA (clot buster) alone is usually not sufficient enough to break the clot. In this case, mechanical thrombectomy is the most effective treatment.

How beneficial is the procedure?

It has become a game changer in the field of stroke care. For many years, the benefits were inconclusive. But with newer generation catheters and technology, in 2015 after 5 major positive clinical trials it has become the standard of care for patients with large vessel occlusion (LVO) strokes.

These studies have shown that 60 percent of patients have good outcomes if they receive this procedure in the first 6 hours. More recently, 2 new trials have shown it was beneficial for select group of patients upto 24 hrs from their stroke onset.

McCarthy, D. J., Diaz, A., Sheinberg, D. L., Snelling, B., Luther, E. M., Chen, S. H., Yavagal, D. R., Peterson, E. C., & Starke, R. M. (2019). Long-Term Outcomes of Mechanical Thrombectomy for Stroke: A Meta-Analysis. TheScientificWorldJournal2019, 7403104.

Do all hospitals offer this treatment ?

As it is a highly specialized procedure performed by interventional radiologists/neurologists and neurosurgeons trained in the specialty, only small percentage of hospitals in the US and around the world offer this treatment.

In the US, approximately 900 hospitals offer mechanical thrombectomy to their patients. Smaller hospitals usually partner with these hospitals allowing for immediate transfer if a patient with a large vessel stroke arrives in their emergency room. Approximately 70 percent of Americans are within 1 hour from a specialized stroke center.

Globally, the number of hospitals offering this treatment in highly variable. Many large cities in under-developed countries do not have even a single  thrombectomy center, thereby leaving thousands of stroke victims from receiving this emergent life saving therapy.