Mechanical Thrombectomy or an Endovascular Procedure
Ischemic stroke treatment begins with first restoring a patient’s breathing, heart rate, and blood pressure back to normal ranges. Once that is accomplished, only then will a physician begin trying to reduce pressure in the brain.
Mechanical thrombectomy is a minimally invasive procedure, ideally done in tandem with intravenous tPA if deemed necessary, in which an interventional radiologist or neurosurgeon uses specialized equipment to remove a clot from a patient’s artery. Using fluoroscopy, or continuous X-ray, the physician guides instruments through the patient’s arteries to the clot, extracting the clot all at once.
The surgeon starts the procedure by making a small incision, to give them to access to an artery. After making the incision, the surgeon threads a catheter through the artery to the clot. Next, they insert a tiny net-like device called a stent retriever into the catheter and guide it to the blockage. They then push the stent retriever through the clot. After the stent retriever is through, it expands to the size of the artery wall. At this point, the stent retriever has captured the clot, and the surgeon is able to pull it out backwards, removing the clot entirely.
This procedure should be done within 6 hours of the onset of symptoms of acute stroke but can benefit certain patients under certain conditions if done within the first day.