Name of the Procedure:

Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic guidance, catheter placement, and intraprocedural pharmacological thrombolytic injection.

Summary

This procedure involves removing blood clots from the arteries within the brain using a catheter (small tube). The technique uses imaging guidance for precision and may also include the administration of clot-dissolving medication. It aims to restore normal blood flow to the brain, essential for preventing further damage during a stroke.

Purpose

The primary goal is to treat acute ischemic strokes caused by blocked arteries in the brain. By removing the clot and restoring blood flow, the procedure aims to minimize brain damage, improve patient outcomes, and reduce stroke-related disability.

Indications

• Sudden onset of stroke symptoms such as weakness, speech difficulties, and loss of coordination.
• Imaging studies (e.g., CT scan, MRI) indicating a blockage in an intracranial artery.
• Patients presenting within a specific window of time from the onset of symptoms (typically within 6-24 hours).

Preparation

• Patients may need to fast for several hours before the procedure.
• Adjustments to current medications, particularly blood thinners, may be required.
• Pre-procedure imaging and diagnostic tests, such as CT angiography or MRI, are conducted to confirm the presence and location of the clot.

Procedure Description

1. The patient is given local anesthesia and sedation or, in some cases, general anesthesia.
2. A small incision is made, usually in the groin area, to access a major artery.
3. A catheter is threaded through the artery up to the site of the clot in the brain using fluoroscopic (X-ray) guidance.
4. The blood clot is removed mechanically using specialized devices or dissolved with thrombolytic medication injected through the catheter.
5. Diagnostic angiography ensures the clot is removed and blood flow is restored.
6. The catheter and any other devices are removed, and the incision site is closed.

Duration

The procedure typically takes between 1 to 3 hours, depending on the complexity and the location of the clot.

Setting

It is performed in a hospital setting, specifically in an interventional radiology suite or a specialized catheterization lab.

Personnel

• Interventional radiologist or neurointerventionalist
• Radiology technologists
• Nurses specializing in interventional procedures
• Anesthesiologist or nurse anesthetist (if general anesthesia is used)

Risks and Complications

• Bleeding at the catheter insertion site
• Vessel injury or perforation
• Allergic reaction to contrast dye
• Stroke or transient ischemic attack (TIA)
• Infection
• Kidney damage due to contrast dye

Benefits

• Potential to significantly restore blood flow and reduce brain damage during a stroke
• Improved chances of recovery and reduced disability post-stroke
• Rapid relief of symptoms if performed promptly

Recovery

• Patients are monitored in a recovery room or intensive care unit immediately after the procedure.
• Instructions may include bed rest and limited movement of the leg used for catheter insertion.
• Follow-up imaging studies and continuous monitoring for any signs of complications.
• Recovery time varies, but most patients can resume normal activities within a few days, depending on stroke severity.

Alternatives

• Intravenous thrombolysis (administration of clot-dissolving medication through a vein)
• Conservative management with medications and rehabilitation
• Surgical options like an open thrombectomy (more invasive)

Patient Experience

• Mild discomfort or pain at the catheter insertion site is common.
• Sedation or anesthesia ensures the patient feels minimal pain during the procedure.
• Post-procedure, patients might feel sore at the incision site and could experience temporary numbness or weakness, which typically improves with time.
• Pain management and comfort measures are provided through medications and supportive care.