When someone suffers a stroke, an innovative surgical treatment called endovascular thrombectomy (EVT) with a stent retriever may help them recover.
EVT, also known as mechanical thrombectomy, is a minimally invasive procedure that can help dissolve blood clots in the brain. Doctors often perform the procedure in conjunction with delivering clot-busting drugs. It can lead to better outcomes for people who have had a stroke.
UPMC neurologists and neurosurgeons are among the most skilled in this procedure, both in western Pennsylvania and the U.S.
Learn more about how the procedure works, who is a candidate, and potential benefits.
What Is Endovascular Thrombectomy?
Endovascular thrombectomy (EVT) is a minimally invasive procedure to remove clots from blood vessels. Doctors use small, thin tubes called catheters and a tiny mesh tube called a stent retriever to remove the clots.
“If someone is having a stroke, it’s usually caused by a blockage in the blood vessel,” says Cynthia Kenmuir, MD, chief, Neurology, and director, Stroke Program and Interventional Program, UPMC Altoona. “We go up inside the blood vessel from either the arm or the leg and, from the inside, we grab ahold of the clot and we pull it out. And so, the blood comes back into the brain and people get better.”
The procedure has become an increased part of the standard of care for stroke in recent years. Before, clot-busting drugs like tPA or TNK were the standard of care. But when used with those drugs, thrombectomy can help lead to better outcomes.
When Is Endovascular Thrombectomy Used?
If a clot in the medium or large blood vessels of your brain causes your stroke, you may be a candidate for EVT.
To determine where a blood clot is, doctors will take an image of your brain.
In addition to the location of the blood clot, timing is also important for whether you can get EVT.
If you can get to the hospital within six hours of your stroke, thrombectomy is the standard of care. If it’s within 24 hours and your brain images indicate enough brain is left to be saved, doctors also can perform the procedure.
“Every minute still counts,” Dr. Kenmuir says. “It really has to be fast.”
How Endovascular Thrombectomy Works
When a stroke patient arrives for treatment, clinical staff take them to get a CT scan right away. There, they meet members of the stroke team. They receive the clot-busting drug intravenously (via IV) to the site of the clot.
Doctors take CT images of the patient’s brain. If the clot is in the medium or large blood vessels of their brain, they go right away to the operating room for endovascular thrombectomy.
“It’s very quick,” Dr. Kenmuir says. “They don’t go back to an emergency department room.”
- Doctors thread a catheter (a long, thin, flexible tube) into an artery in the groin or wrist and up to the chest. They insert smaller tubes through the catheter that go into the neck and into the brain, at the site of the clot.
- Using x-ray guided imaging, they insert a stent retriever — an expandable mesh tube — through the catheter to the site of the clot.
- The stent is expanded at the site of the clot to push the clot against the wall of the artery so blood can flow. It is then “retrieved” — or pulled backward through the catheter — which removes the clot.
Patients are usually awake or have minimal sedation for the procedure.
After the procedure, they go to the intensive care unit (ICU) for at least 24 hours of monitoring and further treatment.
Benefits and Risks of Endovascular Thrombectomy
Removing blood clots from the brain leads to better outcomes for stroke patients, including greater independence and mobility.
When used in conjunction with medical treatments, EVT can reduce stroke-related disability and mortality. If doctors can perform the procedure soon enough after the stroke, some people may see immediate improvement. Others may require further therapy and rehabilitation.
EVT is minimally invasive with minimal sedation.
Like any surgical procedure, thrombectomy has risks. Those include:
- Bleeding into the brain.
- Bleeding and bruising at the catheter site.
Those risks are rare, and doctors do everything they can to minimize the chance of them happening.
“We do talk about risks with the patient,” Dr. Kenmuir says. “That’s part of our consent process every time we do this.”
The Importance of Early Stroke Treatment
Stroke is a leading cause of death and disability in the United States. More than 795,000 Americans have a stroke each year, according to the Centers for Disease Control and Prevention (CDC). Recognizing the symptoms and getting treatment as soon as possible may help prevent severe long-term damage and death.
Dr. Kenmuir says it’s important to seek immediate treatment if you or a loved one is experiencing stroke symptoms. Call 911 or go to the nearest emergency department.
You can recognize stroke symptoms by using the acronym “BE FAST”:
- B (balance): Sudden loss of balance.
- E (eyes): Sudden double vision or vision loss.
- F (face): One side of face drooping.
- A (arms): Numbness or weakness in one arm.
- S (speech): Slurred speech.
- T (time): Act fast by calling 911.
“Trust your body,” Dr. Kenmuir says. “We see so many patients that ignore their stroke symptoms or call 10 other family members first to say, ‘I don’t know, maybe it’ll get better. What do you think I should do?’ Instead, if they have any sudden deficit, whether it’s vision loss, arm or leg weakness, even sudden dizziness, just go to the hospital. It’s well worth the chance.”
UPMC’s multidisciplinary experts provide world-class stroke care, from diagnosis to treatment. To find stroke care near you, visit our website.
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