The future of stroke treatment
For too long has the treatment of stroke only consisted in the rehabilitation and prevention. The event in its acute damaging phase was not treatable. After the successful introduction of clot-busting therapies, where thrombus-dissolving agents are administered intravenously, we have now a mechanical option called thrombectomy available, an intra-arterial clot removing approach.
How does thrombectomy work?
Just like a coronary intervention, cerebral thrombectomy uses intra-arterial catheters to access the area where the blockage occurs. And just like a coronary angiography, the procedure is performed by an interventional cardiologist – perhaps in the future renamed to neuro-cardiologist.
The aim is to quickly Identify the area where the obstruction occurs. This is done with an urgent CT-scan on arrival to the emergency department. In order to be eligible for thrombectomy, the blocked vessel in question must fulfil specific criteria relating to its size and location. Only large vessel occlusion and currently just arteries of the anterior cerebral circulation are amenable to thrombectomy. The time frame in which the clot is to be removed is 6 hours, keeping in mind that faster action delivers better results – time is brain.
The catheter is then inserted via the femoral artery and
What are the dangers?
Complications of endovascular procedures can be related to vessel injury caused by the device like perforation, dissection bleeding, vascular access or radiological contrast media.
What is the future holding?
Rapid, safe and effective arterial recanalisation to restore blood flow to minimise brain damage remains the primary goal when managing acute stroke management. Recent positive randomised clinical trials show that endovascular thrombectomy for large vessel ischaemic stroke substantially improved the outcome and reduced disability. To become available for every future stroke patient, this new technology will demand interdisciplinary co-operation, and no doubt require organisational changes within the care provider as well as public awareness and infrastructure.
A clear and simple demonstration of this procedure can be seen at: