Thrombectomy
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Mechanical thrombectomy, or simply thrombectomy, is the removal of a
Applications in brain
Ischemic stroke represents the fifth most common cause of death in the western world and the number one cause of long-term disability. Until recent times, systemic intravenous fibrinolysis was the only evidence-based therapy for patients with acute onset of stroke due to large vessel occlusion.
In 2015, the results of five trials from different countries were published in the
In 2018 the DAWN and DEFUSE-3 trials were published. These trials showed that mechanical thrombectomy is a safe and effective treatment for individuals who have an acute ischemic stroke, even (in some cases) out to 24 hours after symptom onset.[4][5]
Stent-retriever thrombectomy
The procedure can be performed with general anesthesia or under conscious sedation in an angiographic room. A system of coaxial catheters is pushed inside the arterial circulation, usually through a percutaneous access to the right femoral artery. A microcatheter is finally positioned beyond the occluded segment and a stent-retriever is deployed to catch the thrombus; finally, the stent is pulled out from the artery, usually under continuous aspiration in the larger catheters.[citation needed]
Direct aspiration
A different technique for mechanical thrombectomy in the brain is direct aspiration. It is performed by pushing a large soft aspiration catheter into the occluded vessel and applying direct aspiration to retrieve the thrombus; it can be combined with the stent-retriever technique to achieve higher recanalization rates, but the complexity of the procedure increases.[citation needed]
Direct aspiration has not been studied as thoroughly as stent-retriever thrombectomy, but it is still widely performed because of its relative simplicity and low cost.[citation needed]
Delivery
Patients in London who suffered stroke were found to be much more likely to get thrombectomy in 2022 than those in other parts of England. 42% of thrombectomy units only operated during office hours and Monday to Friday, largely due to a shortage of neuroinerventionalists.[3]
See also
References
- PMID 25882376.
- ^ a b c d e f g Holland, Eva (1 March 2023). "This Revolutionary Stroke Treatment Will Save Millions of Lives. Eventually". The New York Times. Retrieved 1 March 2023.
- ^ a b Moore, Alison (27 July 2022). "Londoners several times more likely to get life-saving treatment". Health Service Journal. Retrieved 28 September 2022.
- PMID 29364767.
- PMID 29129157.