Acute Stroke Mechanical Thrombectomy

Mechanical thrombectomy is indicated for patients who have an acute ischemic stroke caused by a large artery occlusion in the anterior circulation and can be treated within 24 hours of last known good health (ie, at neurologic baseline), regardless of whether they have received intravenous thrombolytic therapy for the same. Mechanical thrombectomy is a minimally invasive technique in which an interventional radiologist removes a clot from a patient's artery using specialised equipment. The doctor uses fluoroscopy, or continuous x-ray, to guide devices through the patient's arteries to the clot, which is then extracted in one piece. For patients with ischemic stroke (IS) who have a proximal major cerebral artery occlusion within 6 hours of onset of symptoms, mechanical thrombectomy (MT) is the standard-of-care treatment.

In patients with anterior circulation ELVO and an NIHSS score of 6 [class I, level A], thrombectomy is recommended. When coupled with disabling symptoms [class IIa, level B-NR], thrombectomy may be considered in individuals with anterior circulation AIS and NIHSS score 6. By 90 days, the overall rate of effective recanalization was 86 percent among 323 AIS patients treated with mechanical thrombectomy, and the overall post-procedure mortality rate was 29 percent. The catheter is then threaded to the clot's site and broken up. Percutaneous mechanical thrombectomy is the name for this less invasive therapy. Venous thrombectomy is a procedure that takes 2 to 3 hours and is done under IV sedation and local anaesthetic.

Thrombectomy, which can be paired with angioplasty, is a procedure in which a cardiologist uses suction to remove blood clots from an artery. It was hoped that by eliminating clots in this way, the risk of heart attacks or other disorders would be reduced.

TICI 2b–3 revascularization is achieved in 58 percent–88 percent of patients using modern thrombectomy techniques,1–3, but up to 45 percent of patients have a poor outcome despite successful revascularization.

modified before stroke Rankin scale: 2, NIH stroke scale: 6, Alberta stroke programme: early CT score: 6.

 St   -Start the procedure within 6 hours of the commencement of symptoms.
 -Internal carotid artery blockage or proximal middle cerebral artery obstruction (M1)
 -Must be at least 18 years old.

Using a patent anterior or posterior connecting artery, a cross-circulation procedure allows access to a brain vascular. Patients with emergent large-vessel occlusions and an unfavourable direct path to the occlusion may benefit from this treatment. We provide the first two cases of trans anterior communicating artery stent retriever thrombectomy, despite the fact that few previous publications have proved an effective cross-circulation approach for treating emergent large-vessel occlusions.

Equipment –

•  Stent retrievers and aspiration devices are examples of equipment.
• guided balloon catheter
• microcatheters.

OUTCOMES -

The mTICI score is used to grade the technical outcome. Thrombectomy is a highly effective treatment for anterior circulation strokes, with a number required to treat (NTT) of 2.6 for a better functional outcome. In a meta-analysis, 46 percent of patients treated with mechanical thrombectomy (modified Rankin scale (mRS) 0–2 at 90 days) gained functional independence, compared to 27 percent of patients treated with optimal medical care.

In posterior circulation strokes, the results are still mixed. In one randomised controlled trial of basilar stroke patients, 44.2 percent of those treated with mechanical thrombectomy achieved a 90-day modified Rankin scale of 0-3, compared to 37.7% of those treated medically, with no statistically significant difference between the two groups.

An 8 or 9F guiding catheter is put through a 10F arrow sheath to construct a double-layered catheter for aspiration thrombectomy.

For Acute Stroke Mechanical Thrombectomy Dr Sandeep Sharma, who is an expert in both suction retrieval and stent retrieval and using both techniques in the perfect way to treat Patients.