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Thrombectomy

Most strokes occur when a clot forms in a blood vessel to the brain and cuts off blood flow to brain cells. In this case, says Dr. Mehmet Akdol, an interventional neuroradiologist at Washington Regional’s J.B. Hunt Transport Services Neuroscience Institute, the goal is to minimize brain injury as much as possible by quickly restoring blood flow through the affected vessel.

“The first thing the stroke team does when the patient shows up at the hospital with an acute stroke is give the patient the clot-buster drug, the IV r-tPA,” he says, referring to tissue plasminogen activator, a protein involved in the breakdown of blood clots. Also known as Alteplase, the drug is administered through an IV in the patient’s arm and is often successful in restoring blood flow.

But for times when the clot busting medication does not dissolve the clot completely or the patient has not arrived at the hospital within the recommended 4-hour window for drug treatment, the stroke team may consider a minimally invasive procedure called thrombectomy. “Thrombectomy is a complementary treatment for an acute stroke intervention,” Dr. Akdol says. As an interventional neuroradiologist, he specializes in endovascular therapies such as thrombectomy.

During this procedure, doctors insert a tiny catheter through an artery in the patient’s groin and thread it up to the blocked artery in the brain. The catheter carries a wire-cage device called a stent retriever, which opens and grabs the clot, Dr. Akdol says, “like a vacuum cleaner or like a corkscrew to take the clot out of the vessel gently.”

Once the clot is removed and normal blood flow is restored, healing can begin. “Although there will be some brain cells lost already, there will be others struggling to survive,” Dr. Akdol says. “If you can restore the blood flow to those tissues and those cells, they will survive the event.”

With a thrombectomy, he says, “Patients can see a better neurological recovery as well as neurological improvement after the episode.”