Thrombectomy

The Thrombectomy Procedure

Thrombectomy is a minimally invasive surgical procedure used to remove blood clots from arteries, particularly in the brain, in patients experiencing acute ischemic strokes. Here is a step-by-step guide to the thrombectomy procedure:

1. Patient Evaluation and Preparation:

• The patient is evaluated to determine if they meet the criteria for thrombectomy, which typically includes a confirmed diagnosis of acute ischemic stroke and the presence of a large vessel occlusion.
• The patient’s medical history, including any allergies, medications, and previous surgeries, is reviewed.
• The patient’s vital signs are monitored, and blood tests may be conducted.

2. Anesthesia:

• The patient is usually given local anesthesia at the site where the catheter will be inserted (e.g., groin) to numb the area. In some cases, general anesthesia may be used.

3. Accessing the Artery:

• A small incision is made in the skin at the site where the catheter will be inserted.
• A catheter is then inserted into a large artery, typically in the groin (femoral artery), and guided through the arterial system using fluoroscopy (real-time X-ray imaging).

4. Advancing the Catheter:

• The catheter is advanced through the arterial system, typically up into the carotid artery or one of its branches, depending on the location of the clot.

5. Clot Retrieval:

• Once the catheter reaches the site of the clot, a specialized device, such as a stent retriever or aspiration catheter, is used to physically remove the clot.
• Stent retrievers are designed to ensnare the clot and allow it to be removed intact, while aspiration catheters use suction to remove the clot.
• The device is carefully maneuvered to engage with the clot without damaging the artery walls.

6. Clot Removal:

• Once the clot is captured by the device, it is slowly withdrawn from the artery, taking care to prevent fragmentation of the clot, which could lead to distal embolization (clot traveling to other parts of the brain).

7. Confirming Revascularization:

• After the clot is removed, angiography (X-ray imaging of blood vessels) is performed to confirm that blood flow has been restored to the affected area of the brain.

8. Closure of the Incision Site:

• After the procedure is completed, the catheter is removed, and the incision site is typically closed using sutures or a closure device.
• Pressure may be applied to the site to prevent bleeding.

9. Post-Procedure Care:

• The patient is closely monitored in a specialized stroke unit or intensive care unit.
• Neurological assessments are performed regularly to monitor for any signs of improvement or complications.

10. Recovery and Rehabilitation:

• Depending on the extent of the stroke and the patient’s overall health, rehabilitation may be necessary to help regain lost function and improve quality of life.