Strokes are a leading cause of disability and death in the U.S. The most common type of stroke, an acute ischemic stroke, is most often caused by a blockage in a blood vessel that supplies blood to the brain. These blockages can occur in the carotid arteries, the main vessels in the neck that deliver blood to the brain, or in the smaller blood vessels within the brain itself.
Ischemic strokes are often first treated with clot dissolving medications. However, interventional neuroradiology techniques can also play a large role in stroke treatment when some of the larger blood vessels within the brain are blocked. There are multiple ways to open up blocked arteries, currently the most common ways are using a long hollow plastic tube called a “distal access catheter” and suctioning out the clot and using devices called stent retrievers that can be placed within those blood vessels to remove the clot blocking the blood flow and causing the stroke.
Stroke Treatment, Neurothrombectomy (typically an emergency procedure)
After receiving clot-busting drugs in the emergency room, you may qualify for a special procedure where we physically remove a clot from inside the brain blood vessels using a stent retriever. You may also qualify for this procedure even if you don’t receive any type of medication because you arrived at the emergency room too late. A stent can help prop open a narrowed blood vessel and to help us capture and remove a clot in the brain. These procedures are extremely time sensitive, as the brain suffers irreversible damage very quickly following a stroke, so only a select number of patients can benefit from these emergency procedures.
The neurovascular specialists at the Johnston-Willis Comprehensive Stroke Center (and other facilities where this procedure is performed) use the most modern techniques to open blood vessels in the brain after a stroke. Currently we most often a special plastic tube (distal access catheter) that allows us, through suction, to safely remove clots from brain arteries, we also use a device called a TREVO stent retriever but other devices and techniques including the PENUMBRA aspiration device may be utilized. These techniques remove clots in the arteries in the brain (cerebral arteries), which are not always successfully treated with clot-busting drugs or in those who may not qualify for receiving the clot busting drugs. Removing clots often results in better outcomes for stroke patients.
What happens during a Neurothrombectomy?
You or a family member will have already discussed the treatment options and the benefits and risks with your physician doing the procedure.
We’ll take you to a special room similar to an operating room. Things may seem quite hectic as time is of the essence when dealing with stroke and nurses and assistants may be quite busy getting things ready for your procedure. We sometimes use general anesthesia, so you may not be aware of the remainder of the procedure. Some patients receive conscious sedation, or moderate anesthesia, in which you remain slightly awake. We will monitor your pulse, blood pressure, and your breathing throughout the procedure.
During the procedure, you’ll lie on your back on a table and we’ll clean the area where the catheter (a thin, hollow tube) will enter your body using a special solution to minimize infection. We’ll place sterile drapes over your body and the neurointerventionalist will apply a local anesthetic so you don’t feel any pain.
Your neurointerventionist will make a small incision in your groin to insert the catheter along with a thin guide wire. We’ll place multiple progressively smaller tubes in the carotid artery (in your neck). Finally, we’ll advance a tiny microcatheter into the brain blood vessels until it goes just beyond the clot. The suction catheter (DAC) or TREVO stent is then inserted up to or through the clot, we’ll suction out the clot or grab the clot, and withdraw the ensnared clot. This procedure may have to be repeated several times until the entire clot is removed (if possible).
At the end of the procedure, your neurointerventionalist will withdraw the catheter and will usually place a special device in the blood vessel to stop the blood from leaking out. Finally, we’ll put a bandage over the incision. You will typically be taken to the Neuro Intensive care unit after this procedure.