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Mechanical thrombectomy, or simply thrombectomy, is the interventional procedure of removing a blood clot (thrombus) from a blood vessel. It is commonly performed in the coronary arteries (interventional cardiology), peripheral arteries (interventional radiology) and cerebral arteries (interventional neuroradiology).
Applications in brain
Ischemic stroke represents the second death cause in western world. Until recent times, systemic intravenous fibrinolysis was the only evidence-based therapy for patient with acute onset of stroke due to large vessel occlusion.
In 2015, the results of five trials from different countries were published on one of the most prestigious medical journal, the New England Journal of Medicine, demonstrating the safety and efficacy of mechanical thrombectomy with stent-retriever to achieve a better outcome and reduce mortality. It is now a widespread procedure performed in most primary stroke center all over the planet, especially in the developed world.
The procedure is usually performed under general anesthesia in angiographic room. A system of coaxial catheters is pushed inside the arterial circulation, usually through a percutaneous access to the 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 with under continous aspiration in the larger catheters.
A different technique for mechanical thrombectomy in brain is direct aspiration. It is performed pushing a large (but very soft) aspiration catheter in the occluded vessel, and applying direct aspiration to retrieve the thrombus; it can be combined with stent-retriever technique to achieve higher recanalization rates, but the complexity of the procedure increases.
Direct aspiration still lacks the evidence collected for stent-retriever thrombectomy, yet it is widely performed because of its relative semplicity and inexpensiveness.
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