Question

A 60-year-old hypertensive male is brought to a Stroke unit with acute onset right hemiparesis and aphasia (NIHSS score 16) of 8 hours duration.
Describe the procedure of aspiration thrombectomy in acute middle cerebral artery occlusion.

Hint:

Aspiration thrombectomy is effective for large vessel occlusions and can significantly improve outcomes when performed early.

Answer 1

Aspiration thrombectomy is a procedure used to remove a clot from a blood vessel, especially in cases of acute middle cerebral artery occlusion.
Step 1: Preparation:
- The patient is placed under general anesthesia.
- The access site, usually the femoral artery, is prepared and a sheath is inserted.
Step 2: Catheter Insertion:
- A catheter is inserted through the femoral artery and advanced to the site of the occlusion in the middle cerebral artery.
- A guidewire may be used to navigate the catheter.
Step 3: Aspiration:
- A thrombectomy device is connected to the catheter, which uses suction to aspirate and remove the clot from the artery.
- The clot is removed as the catheter is withdrawn.
Step 4: Post-Procedure Monitoring:
- After the clot is removed, the patient is monitored for complications such as hemorrhagic transformation or re-occlusion.
Step 5: Secondary Stroke Prevention:
- Post-procedure management includes antiplatelet therapy, anticoagulation, and monitoring for complications.