Johnston-Willis Hospital - February 01, 2019

When 65 year-old Janet became confused and experienced numbness in her arm, she was fortunate that her friend recognized her symptoms as a stroke and immediately called 911. At the hospital, doctors performed a procedure, called a neurothrombectomy, to remove the clot that was blocking the flow of blood to her brain. Today, Janet has made an almost complete recovery. Without the thrombectomy, though, it is likely that her speech would be impaired and she would be completely paralyzed on the left side of her body.

What is a blood clot?

Arteries and veins are vessels that make up part of the body’s circulation system. Arteries carry oxygen and nutrients throughout the body. Veins carry blood back to the heart. Sometimes, blood thickens and sticks together, forming a blood clot. If the clot blocks the blood from flowing through an artery that supplies the brain, it can cause the surrounding tissue to begin to die. If the clot is removed quickly, blood can flow freely through the blood vessels again and brain function can be restored.

When a blood clot blocks the flow of blood to the brain, it is called a stroke. Atrial fibrillation and blockages in the arteries of the head and neck are 2 conditions that can cause a blood clot to form.

What are the warning signs of a stroke?

A stroke can be caused by either bleeding into the brain, or more commonly by a blood clot that blocks the flow of blood to the brain, and can result in serious disability or death. Before any treatment can be rendered, it is important to know the symptoms of a stroke and to seek medical help immediately. The American Stroke Association® uses the acronym F-A-S-T to help remember the warning signs of a stroke1:

B-Balance

E-Eyes, Vision

F-Face Drooping

A-Arm Weakness

S-Speech Difficulty

T-Time to Call 911

Other symptoms may include:

  • Numbness or weakness in the face, arm, or leg, located on 1 side of the body
  • Confusion or trouble understanding
  • Trouble seeing in 1 or both eyes
  • Sudden dizziness, trouble walking, loss of balance or coordination
  • Sudden and severe headache with no obvious cause

“About 750,000 people a year suffer strokes in the United States, and 85 percent of those are caused by clots”, according to an article in The New York Times.2 Calling 911 and getting treatment as soon as possible provides the best chance for avoiding long-term disability or death.

Stroke. Copyright© Nucleus Medical Media, Inc.

What is a thrombectomy?

Thrombectomy is an invasive medical procedure that removes blood clot(s) from inside an artery or vein. A neurothrombectomy is a very specialized procedure performed by physicians known as Neurovascular surgeons or neurointerventionalists. It can be performed on patients who first experienced the signs of a stroke within the past 24 hours. Neurothrombectomy, (sometimes combined with clot-dissolving medicine) results in significantly improved outcomes for the patient. “The faster a blood clot causing a stroke is removed, the less disability a patient may have”, according to research presented at the American Stroke Association’s International Stroke Conference in 2016.

What are the risks of thrombectomy?

All surgery has some risks. Risks associated with a neurothrombectomy include:3

  • Excess bleeding severe enough to cause death
  • Damage to the blood vessel at the site of the blood clot
  • Reaction to anesthesia
  • Blood clots can travel to other parts of the brain

The success of the procedure also depends on the overall health of the patient, how long the clot has been there, and where it is located in the brain.

How is a neurothrombectomy performed?

If a blood clot is large and causing damage to surrounding tissue, a thrombectomy may be recommended to remove the clot. The neurovascular physician has special tests (Rapid CT perfusion) to determine if the damage to the brain is reversible and if the patient will possibly benefit from a neurothrombectomy. In the case of a stroke, it is typically an emergency procedure. In the case of clots located in other parts of the body, it can be a planned procedure:3

Prior to a Thrombectomy Procedure

Before the procedure, tell your doctor about any medications or supplements that you take, especially blood thinners.

During the Procedure

The thrombectomy procedure may differ slightly depending on the part of the brain or sometimes the neck blood vessels where the clot is found. Your doctor will explain what to expect during your own procedure. In a typical neurothrombectomy surgery:

  • An intravenous (IV) line will be put into your arm or hand before the procedure starts. You will receive medicines through this IV, including sometimes a blood thinner that will help prevent new clots from forming during the surgery.
  • Anesthesia or sedation medications also will be administered through the IV line. Anesthesia will prevent pain and keep you asleep throughout the surgery. Sedation will make you relaxed and sleepy during surgery.
  • The surgeon will use continuous x-ray images called fluoroscopy while the surgery is being done.
  • The artery at your groin area is typically the safest place to do the surgery.
  • The skin over the artery is numbed with lidocaine/xylocaine.
  • A special flexible plastic tube, like a long straw, is placed in the artery. This tube is guided to the brain blood vessels using special techniques. Another special very flexible tube (catheter) designed to remove blood clots from the brain or a special removable stent are used to grasp and remove the blood clot.
  • A stent may be rarely placed in the blood vessel to help keep it open.
  • The tubes/catheters will be all removed and the hole in the blood vessel will then be repaired to allow blood to flow freely and not leak out.
  • The incision will be closed and bandaged.

Following the Procedure

At the Hospital:

After the procedure, you will go to the special Neuro Science Intensive Care Unit, where a medical team will monitor heart rate, breathing, and other vital signs. You will probably stay in the hospital for several days and may require special rehabilitation to help you recover from your stroke.

At Home:

After the thrombectomy, you may need to take medicine for a while or possibly for the rest of your life, to help prevent additional blood clots. You also can take pain medicine, if needed. If you smoke, it raises the risk of blood clots. Your doctor can advise you on programs to help you quit.

Make sure to follow your doctor’s instructions regarding medications to take, exercising, and taking care of your wound. Keep all of your follow-up appointments with your doctor.

When to Call Your Doctor

Call your healthcare provider right away if you have any of the following:

  • Swelling or pain that gets worse
  • Fluid leaking from the incision
  • Fever
  • Bleeding anywhere on your body
  • Weakness, pain, or numbness in the surgery area

If you think you have a medical emergency, call 911 right away.

Sources:

1American Stroke Association®: www.strokeassociation.org

2New York Times, “New Findings Could Save Lives of More Stroke Patients.” January 24, 2018. Denise Grady. www.nytimes.com/2018/01/24/health/stroke-clots-brain.html