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Mechanical Thrombectomy for Acute Ischaemic Stroke

A life-saving, emergency procedure that uses a tiny device to mechanically remove a blood clot from a blocked brain artery restoring blood flow and minimising permanent neurological damage.

Emergency Neuro-Interventional Procedure

What is Mechanical Thrombectomy?

Mechanical thrombectomy (also called endovascular thrombectomy or clot retrieval) is an emergency, minimally invasive procedure used to treat acute ischaemic stroke caused by a large vessel occlusion (LVO). It involves navigating a specialised stent-retriever device or aspiration catheter through the blood vessels to the blocked artery in the brain, physically grabbing the clot and removing it restoring blood flow within minutes.

This procedure has revolutionised stroke care. Prior to its advent, outcomes from large vessel strokes were often devastating. Today, when performed by an experienced interventional radiologist like Dr. Gurucharan S Shetty within the treatment window, thrombectomy can result in dramatic neurological recovery even in patients presenting with complete paralysis or inability to speak.

Who is a Candidate for Thrombectomy?

Mechanical thrombectomy is indicated for patients with acute ischaemic stroke caused by occlusion of a major cerebral artery such as the internal carotid artery (ICA), middle cerebral artery (MCA), or basilar artery. It is most effective when performed within 6 hours of symptom onset, although in selected patients with salvageable brain tissue identified on imaging, the treatment window can be extended up to 24 hours. Candidates typically present with a significant neurological deficit, often reflected by an NIHSS score of 6 or higher, indicating a large area of brain at risk. Imaging with CT or MRI should demonstrate a large vessel occlusion with a substantial amount of still-viable brain tissue, known as the penumbra. The procedure is suitable for patients who have already received intravenous thrombolysis or for those who are not eligible for clot-dissolving medications.

How is the Procedure Performed?

  • Rapid Imaging: A CT scan with CT angiography is performed immediately to confirm LVO and assess how much brain tissue is salvageable.
  • Groin Access: Under local anaesthesia or general anaesthesia, a catheter is inserted through the femoral artery in the groin.
  • Navigating to the Clot: Using live X-ray (fluoroscopy) and contrast dye, a microcatheter is advanced through the carotid and cerebral arteries to reach the site of the blockage.
  • Clot Removal: A stent retriever is deployed across the clot it interlocks with the clot and both are withdrawn together. Alternatively, a large bore aspiration catheter suctions the clot directly.
  • Confirmation: A final angiogram confirms successful vessel recanalization and restoration of blood flow to the brain.
  • Post-procedure Care: The patient is monitored in the neuro-ICU. Neurological status is assessed every hour. Most patients show improvement within hours of successful recanalization.
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Benefits of Mechanical Thrombectomy?

Rapid Recovery

Many patients experience dramatic neurological improvement within hours of successful clot removal.

Minimally Invasive

No brain surgery the clot is removed through a tiny catheter inserted at the groin.

Broad Treatment Window

Eligible patients can be treated up to 24 hours after stroke onset with advanced imaging selection.

Proven by Evidence

Multiple landmark international trials confirm significantly better outcomes over medical management alone.

Frequently Asked Questions

The earlier the better ideally within 6 hours of symptom onset. However, with modern perfusion imaging (CT perfusion or MRI), patients with salvageable brain tissue can be treated up to 24 hours after onset. Every 15 minutes of delay results in approximately 4 million more neurons dying which is why "time is brain."
It can be performed under either conscious sedation or general anaesthesia depending on the patient's neurological status and the team's preference. Recent evidence suggests conscious sedation may be preferable in many cases as it allows for neurological monitoring during the procedure.
Successful vessel recanalization (reopening the blocked artery) is achieved in approximately 70–90% of cases with modern devices. Functional independence at 3 months is achieved in 46–60% of treated patients compared to around 26% with medical therapy alone, depending on the trial and patient population.
Yes. IV alteplase (tPA) is administered when eligible as a bridge therapy while the patient is being brought to the angiography suite. Thrombectomy then addresses the large clot that tPA alone rarely dissolves. This combined approach is standard of care in eligible patients.
Successful recanalization often results in significant improvement, but many patients still require physiotherapy, speech therapy, and occupational therapy. Neurological recovery continues for months to years after the event. Early rehabilitation initiation (within 24–48 hours) is strongly recommended.
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