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Thrombectomy

From Wikipedia, the free encyclopedia

Image
Removal of a blood clot (top) using an intra-arterial mesh retriever and suction

Mechanical thrombectomy, or simply thrombectomy, is the removal of a blood clot (thrombus) from a blood vessel, often and especially endovascularly as an interventional radiology procedure called endovascular thrombectomy. It contrasts with thrombolysis (clot dissolution) by thrombolytic medications (e.g., alteplase, reteplase), as either an alternative or complement.

Thrombectomy is commonly performed in the cerebral arteries as treatment to reverse the ischemia in some ischemic strokes (i.e., those in which the blockage is a suitable candidate for such retrieval). Open vascular surgery versions of thrombectomy also exist. The effectiveness of thrombectomy for strokes was confirmed in clinical research conducted in 2015.[1]

Applications in brain

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Mechanical thrombectomy can be used to remove blood clots from the brain.[2][3] An interventional neuroradiology procedure uses an aspiration catheter inserted through the groin to apply a retriever, or, in some cases, suction, to capture and remove the clot.[1][4]

Mechanical thrombectomy can be used within 24 hours after the stroke has occurred.[1][4] It is the standard of care for large vessel occlusions, with studies showing a significant increase in functionality compared to medication without intervention.[1]

History

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Early endovascular treatments (Intra-arterial thrombolysis) released of clot-dissolving pro-urokinase through a catheter in proximity to the clot. They did not have sufficient benefits compared to alternative treatments, caused complications such as intracranial haemorrhage, and never received FDA approval for this indication.[5][6] In response, multiple new devices were developed, with MERCI Retriever showing early success with using a wire to ensnare and pull out the thrombus. Later, Penumbra System, which used clot debulking and mechanical retrieval as a backup, was introduced, with a study showing that it was comparable to MERCI. However, both had limited clinical benefits.[5][6]

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Commemorative plaque for the first successful stent-retriever thrombectomy, performed by Hans Henkes at Klinikum Stuttgart (2008)

In the late 2000s, the use of stent retrievers for intracranial thrombectomy began.[1][5] A retrievable stent for thrombus and foreign material removal was reported in 2003.[7] The first successful stent retriever thrombectomy was performed in 2008 with a Solitaire stent, which was approved to treat aneurysms and used off-label because other treatments were unsuitable, unavailable, or had already failed.[8][9] Solitaire FR and Trevo Retriever were developed in the aftermath, with trials following soon after.[10][11] Both new devices were shown to be superior.[5]

Early trials called Synthesis,[12] MR Rescue,[13] and IMS III[14] were published in 2013, with none of them showing clear clinical benefits.

Later research indicated that issues with patient selection, the use of less effective or older devices, and slow workflows may have adversely affected outcomes.[6] Starting in 2015, multiple studies confirmed the viability of the treatment due to a significant improvement in outcomes after mechanical thrombectomy compared to medical intervention alone.[1][15] Studies also extended the evidence for positive outcomes beyond six hours after clinical onset,[16][17] while some other studies showed benefits for people in higher-risk groups,[18] and for specific kinds of strokes.[19][20]

Basilar artery occlusion

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For people with basilar artery occlusion, thrombectomy improved outcomes with good functionality from 23% to 46%, and reduced mortality from 55% to 37%.[20] A 2024 study confirmed a significant decrease in death and disability as well as an improvement in quality of life.[19]

Potential complications can occur within and outside the head. Complications outside the head (extracranial) include dissection and vasospasm, and intracranial dissection, vasospasm, stenosis, and embolization can also occur. There does not seem to be a significant increase in complications in treatments that occur multiple hours after the stroke.[21]

See also

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References

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  1. 1 2 3 4 5 6 Saver JL, Goyal M, Bonafe A, et al. (June 11, 2015). "Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke". New England Journal of Medicine. 372 (24): 2285–2295. doi:10.1056/NEJMoa1415061. PMID 25882376.
  2. ↑ Chen H, Lee JS, Michel P, et al. (October 2024). "Endovascular Stroke Thrombectomy for Patients With Large Ischemic Core: A Review". JAMA Neurology. 81 (10): 1085–1093. doi:10.1001/jamaneurol.2024.2500. PMID 39133467.
  3. ↑ Mathews S, De Jesus O (2026), "Thrombectomy", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32965825, retrieved July 9, 2026
  4. 1 2 Sarraj A, Hassan AE, Abraham MG, et al. (March 2024). "Endovascular Thrombectomy for Large Ischemic Stroke Across Ischemic Injury and Penumbra Profiles". JAMA. 331 (9): 750–763. doi:10.1001/jama.2024.0572. PMC 10851143. PMID 38324414.
  5. 1 2 3 4 Bageac DV, Gershon BS, De Leacy RA (2021), "The Evolution of Devices and Techniques in Endovascular Stroke Therapy", in Dehkharghani S (ed.), Stroke, Brisbane (AU): Exon Publications, ISBN 978-0-6450017-6-1, PMID 34279890, retrieved July 6, 2026
  6. 1 2 3 Boyle K, Joundi RA, Aviv RI (February 27, 2017). "An historical and contemporary review of endovascular therapy for acute ischemic stroke". Neurovascular Imaging. 3 (1) 1. doi:10.1186/s40809-016-0025-2. ISSN 2055-5792.
  7. ↑ Henkes H, Flesser A, Brew S, et al. (December 20, 2003). "A novel microcatheter-delivered, highly-flexible and fully-retrievable stent, specifically designed for intracranial use. Technical note". Interventional Neuroradiology: Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences. 9 (4): 391–393. doi:10.1177/159101990300900411. ISSN 1591-0199. PMC 3547382. PMID 20591320.
  8. ↑ Pérez MA, Miloslavski E, Fischer S, et al. (November 2012). "Intracranial thrombectomy using the Solitaire stent: a historical vignette". Journal of NeuroInterventional Surgery. 4 (6): e32. doi:10.1136/neurintsurg-2011-010149. ISSN 1759-8486. PMC 3465948. PMID 22170823.
  9. ↑ Kühn AL, Vardar Z, Kraitem A, et al. (December 2020). "Biomechanics and hemodynamics of stent-retrievers". Journal of Cerebral Blood Flow and Metabolism. 40 (12): 2350–2365. doi:10.1177/0271678X20916002. ISSN 1559-7016. PMC 7820689. PMID 32428424.
  10. ↑ Saver JL, Jahan R, Levy EI, et al. (October 2012). "Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial". The Lancet. 380 (9849): 1241–1249. doi:10.1016/S0140-6736(12)61384-1. PMID 22932715.
  11. ↑ Nogueira RG, Lutsep HL, Gupta R, et al. (October 2012). "Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial". The Lancet. 380 (9849): 1231–1240. doi:10.1016/S0140-6736(12)61299-9. PMC 4176618. PMID 22932714.
  12. ↑ Ciccone A, Valvassori L, Nichelatti M, et al. (March 7, 2013). "Endovascular Treatment for Acute Ischemic Stroke". New England Journal of Medicine. 368 (10): 904–913. doi:10.1056/NEJMoa1213701. ISSN 0028-4793. PMC 3708480. PMID 23387822.
  13. ↑ Kidwell CS, Jahan R, Gornbein J, et al. (March 7, 2013). "A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke". New England Journal of Medicine. 368 (10): 914–923. doi:10.1056/NEJMoa1212793. ISSN 0028-4793. PMC 3690785. PMID 23394476.
  14. ↑ Broderick JP, Palesch YY, Demchuk AM, et al. (March 7, 2013). "Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke". New England Journal of Medicine. 368 (10): 893–903. doi:10.1056/NEJMoa1214300. ISSN 0028-4793. PMC 3651875. PMID 23390923.
  15. ↑ Goyal M, Menon BK, van Zwam WH, et al. (April 23, 2016). "Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials". Lancet. 387 (10029): 1723–1731. doi:10.1016/S0140-6736(16)00163-X. ISSN 1474-547X. PMID 26898852.
  16. ↑ Nogueira RG, Jadhav AP, Haussen DC, et al. (January 4, 2018). "Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct". The New England Journal of Medicine. 378 (1): 11–21. doi:10.1056/NEJMoa1706442. ISSN 1533-4406. PMID 29129157.
  17. ↑ Albers GW, Marks MP, Kemp S, et al. (February 22, 2018). "Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging". The New England Journal of Medicine. 378 (8): 708–718. doi:10.1056/NEJMoa1713973. ISSN 1533-4406. PMC 6590673. PMID 29364767.
  18. ↑ Mattar A, Cao R, Torche E, et al. (July 2026). "Mid-term outcomes of mechanical thrombectomy for Acute Ischemic stroke in patients with active cancer: a propensity-matched study". Journal of Stroke and Cerebrovascular Diseases. 35 (7) 108657. doi:10.1016/j.jstrokecerebrovasdis.2026.108657. ISSN 1532-8511. PMID 42103178.
  19. 1 2 Thomalla G, Fiehler J, Subtil F, et al. (September 2024). "Endovascular thrombectomy for acute ischaemic stroke with established large infarct (TENSION): 12-month outcomes of a multicentre, open-label, randomised trial". The Lancet. Neurology. 23 (9): 883–892. doi:10.1016/S1474-4422(24)00278-3. hdl:10486/714627. ISSN 1474-4465. PMID 39074480.
  20. 1 2 Tao C, Nogueira RG, Zhu Y, et al. (October 12, 2022). "Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion". New England Journal of Medicine. 387 (15): 1361–1372. doi:10.1056/NEJMoa2206317. ISSN 0028-4793. PMID 36239644.
  21. ↑ Pilgram-Pastor SM, Piechowiak EI, Dobrocky T, et al. (October 2021). "Stroke thrombectomy complication management". Journal of NeuroInterventional Surgery. 13 (10): 912–917. doi:10.1136/neurintsurg-2021-017349. ISSN 1759-8478. PMC 8458081. PMID 34158401.
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