Nurse Assessing Stroke Victim By Raising Arms

Vikas Patel on the Recent Advances in Mechanical Thrombectomy for Strokes

In the United States, nearly 800,000 people suffer from a stroke each year. Three-quarters of all strokes happen in people who are 65 and older. A person’s risk of a stroke doubles with each decade passed after reaching the age of 55.

Vikas Patel, an interventional neuroradiologist from New Jersey, explains the effects of a stroke and their risk factors and treatment options, including mechanical thrombectomy. There have been many important advances in mechanical thrombectomy in recent years.

What is a Stroke?
The definition of a stroke is an interruption to the brain’s blood supply. Most strokes are ischemic strokes, which result from the immediate blockage of an artery providing blood to the vein. Another type of stroke is the hemorrhagic stroke, caused by a brain bleed after a blood vessel has burst.

Both types of stroke can cause similar symptoms. The symptoms of a stroke include weakness, inability to control the body, numbness, and loss of sensation. A stroke can also cause trouble with seeing, walking, or speaking. Since different areas of the brain control different body functions, having a stroke in a specific area may lead to specific symptoms. Often, stroke sufferers will present with a headache, but sometimes a stroke is painless.

After effects
The after effects of a stroke can be devastating. Without immediate medical treatment, the symptoms of a stroke will become permanent. Even when a patient is treated appropriately for their stroke, the symptoms such as speaking and walking difficulties may be permanent.

Risk Factors
There are many lifestyle risks for stroke which can be controlled. Uncontrolled high blood pressure is the leading cause of strokes. Diabetes, heart disease, and smoking are also leading causes. The risk of stroke is connected to a person’s age and gender. Men are most likely to have strokes, but women are more likely to die from them.

Having a personal or family history of strokes is an important risk factor. Brain aneurysms can also lead to strokes.

Treatment with Mechanical Thrombectomy
Mechanical thrombectomy involves the removal of a blood clot (thrombus) from a vessel. This procedure can alleviate the effects of a stroke or prevent a further, more serious stroke from occurring. Interventional Neuroradiologists like Vikas Patel are skilled in performing this procedure.

Mechanical thrombectomy is a new, minimally invasive treatment for clots that can cause strokes. This procedure is guided by fluoroscopy or the use of continuous x-rays. The doctor is able to guide instruments through the arteries and reach the clot. The doctor is then able to remove the clot.

The procedure for clot removal starts with a small incision in the upper thigh or the wrist. The doctor sends a catheter through the artery until it reaches the clot. The next step is inserting a small device resembling a net through the artery. This is called a stent retriever.

The stent retriever is pushed into the clot. After the stent retriever has been pushed through the clot, it grows to match the size of the artery, capturing the clot. The doctor is then able to pull the clot out using the catheter.

Conditions Treated by Mechanical Thrombectomy
Mechanical thrombectomy treats not only ischemic strokes, but also treats deep vein thrombosis or DVT. In this dangerous condition, blood clots form in the legs or arms that can permanently damage the valves inside the veins. This can cause many different problems with the leg or arm, including swelling, sores, and pain.

In some cases, a clot from a DVT can break off and become lodged in the brain. This causes a life-threatening condition called a cerebral venous thrombosis. This condition can present with headaches, vision loss, speech impairment, weakness and sensory loss, and coma. The condition is treated with blood thinners and endovascular treatment with mechanical thrombectomy involving aspiration of the clot and stent retrievers. 

Advances in Mechanical Thrombectomy
The use of the stent retriever has made huge strides in the treatment of strokes. In the past, patients with clots in the brain may have had to wait with previously available medical treatment. Since a stroke is a life-or-death situation and can cause permanent disability, doctors need to move quickly. The non-invasive treatment of mechanical thrombectomy has increased the likelihood that a patient will recover from a stroke.

Medical trials suggest that the number of moderate to severe stroke patients who recover fully may be as high as 50 percent. This is compared to the mere 10 percent who recovered fully using previously known medical treatments. Mechanical thrombectomy has the potential to save lives and to restore function to a disabled person.

One major advance made in mechanical thrombectomy is the pre-screening of patients. Using CT or MRI scans helps doctors pinpoint the location of the clot.

Risks of Mechanical Thrombectomy
While mechanical thrombectomy is a generally safe procedure, up to 5 percent of patients may experience damaging effects. Other blood clots can move into the brain, causing another stroke. When patients are carefully prescreened, these problems are less likely to occur.

Amazing Medical Advances
Over the past five years, mechanical thrombectomy has made incredible strides. Many patients who would have been given a negative prognosis are able to recover, in whole or in part, thanks to the procedure. Since the treatment is minimally invasive, it carries fewer risks than other procedures.

Vikas Patel recommends that all patients presenting with stroke symptoms find hospitals with access to mechanical thrombectomy techniques. This procedure can both save lives and promote a better quality of life for stroke sufferers.