thrombectomy

A thrombectomy is an interventional procedure to remove a thrombus from a blood vessel. It is most commonly performed endovascularly, using catheters introduced through the arterial system to reach the site of occlusion, and can involve mechanical devices to extract or disrupt the clot. The term covers methods aimed at restoring blood flow in arteries or veins and includes mechanical thrombectomy and surgical thrombectomy, though modern practice emphasizes endovascular mechanical techniques.

In acute ischemic stroke caused by occlusion of a large cerebral artery, mechanical thrombectomy is a standard of care when a large vessel occlusion is identified and patient selection criteria are met. The procedure is typically done within a time window after symptom onset, with extended selection allowing certain patients up to 24 hours based on perfusion imaging. Pre-procedure imaging and clinical evaluation determine eligibility.

Techniques and devices: commonly used devices include stent retrievers and aspiration catheters. A common approach may combine stent deployment with retrieval, sometimes using a balloon-guide catheter to reduce distal emboli. The goal is successful reperfusion, graded by scales such as the TICI score; successful reperfusion improves functional outcomes compared with medical management alone.

Risks include intracranial hemorrhage, vessel injury, dissection, distal embolization, and contrast-related complications. The procedure requires specialized expertise and is associated with resource intensity. Outside stroke, thrombectomy also applies to other conditions such as cerebral venous sinus thrombosis and certain cases of pulmonary embolism or peripheral arterial occlusions, depending on patient factors and local expertise. Ongoing research continues to refine patient selection, devices, and techniques.