Endovascular treatment of stroke

What is an endovascular treatment of stroke?

Endovascular treatment of stroke is the non-surgical treatment for the sudden loss of brain function due to blood clots in large vessels of the brain. The treatment uses microcatheters (thin tubes visible under X-rays) which are inserted into the blood clot from the groin or the arm. The blood clot is removed from the blood vessel using devices which capture the clot or suck the clot out – this procedure is called a thrombectomy. If the blood clot cannot be removed, it is liquefied using drugs delivered through the catheter, in a procedure known as thrombolysis.

How does the procedure work?

The interventional radiologist will insert a catheter into an artery in your arm or groin and move it towards the blood clot under X-ray guidance. The blood clot is removed in a procedure called a thrombectomy. The blood clot may be removed by trapping it in a stent which is then pulled out with the clot, or the interventional radiologist may suck the clot out through the catheter.

If the clot cannot be removed, a medication may be applied through the catheter to liquefy it. If the blood vessel is too narrow, a balloon catheter can be used to restore its original size, in a procedure called an angioplasty. Afterwards, a stent is inserted to hold the blood vessel open.

Why perform it?

If you have suffered stroke caused by a blockage in a large artery but you are not suitable for or have not responded to thrombolysis, this procedure is a possible treatment for you. If performed within a safe period, the treatment helps the part of the brain tissue that is oxygen starved and not completely damaged to recover.

What are the risks?

The insertion of catheters and guidewires in arteries to the brain carries a low but definite risk of bleeding or the movement of blood clots to previously unaffected parts of the brain. Endovascular treatment is inadvisable if your admission to hospital after the stroke was delayed, as this carries a higher risk of complications.

Bibliography

1. Sacks D, Black CM, Cognard C, Connors JJ 3rd, Frei D, Gupta R, Jovin TG, Kluck B, Meyers PM, Murphy KJ, Ramee S, Rüfenacht DA, Bernadette Stallmeyer MJ, Vorwerk D. Multisociety consensus quality improvement guidelines for intraarterial catheter-directed treatment of acute ischemic stroke, from the American Society of Neuroradiology, Canadian Interventional Radiology Association, Cardiovascular and Interventional Radiological Society of Europe, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, European Society of Minimally Invasive Neurological Therapy, and Society of Vascular and Interventional Neurology. J Vasc Interv Radiol. 2013 Feb; 24(2):151-63.