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Acute Stroke Revascularization by Thrombolysis and Embolectomy

Acute Stroke Revascularization by Thrombolysis and Embolectomy

When a person has a stroke, the blood flow in an artery that supplies blood to the brain is completely blocked by the buildup of plaque in the artery or the development of a blood clot. Without the usual blood supply, neurons will die quickly, resulting in serious complications and even death. Stroke is the third leading cause of death in United States, causing more than 150,000 deaths each year. The rapid reestablishment of blood flow through the artery, called revascularization, is the most critical aspect of stroke treatment.

Interventional neuroradiology is a relatively new specialty that addresses problems with the blood vessels that supply the nervous system from inside the vessels themselves, which is called an endovascular approach.

Treatment

In the case of a patient with a stroke, for example, there are two endovascular strategies that can help restore normal blood flow-thrombolysis, the dissolving of the clot, and embolectomy, the extraction of the clot.

Thrombolysis, or the use of an agent to dissolve a clot, is a common treatment for stroke patients, provided it can be administered in time. When given through a vein in the arm, the thrombolytic agent tissue plasminogen activator (tPA), for example, must be given within three hours of the onset of symptoms. After those three hours, however, tPA still can be used if it can be administered directly to the clot. Interventional neuroradiologists can guide a catheter, usually through an artery in the groin, all the way up to the site of the occlusion, to administer tPA directly. This reduces the risk of side effects and increases the chances that the vessel can be cleared, compared with intravenous administration. In addition, interventional neuroradiologists may use an angioplasty balloon, which inflates in an artery to dislodge occlusions, to disrupt the clot and improve the exposure of the clot to the thrombolytic agent.

The other interventional neuroradiology procedure that now is being used to restore blood flow in stroke patients is an experimental procedure called embolectomy. When a clot blocks an artery it is known as an embolus. Embolectomy is the removal of the clot with a catheter. The catheter, which is guided up from an artery in the groin to the site of the clot, deploys a special wire with loops in it. This wire threads through the embolus, gripping it so it can be pulled out. The procedure can be performed within eight hours of symptom onset.

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