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BRAIN ATTACK:

Mechanical Thrombectomy For Severe Acute Stroke

By Dr. Himanshu Agarwal in Interventional Neurology

Oct 20 , 2022 | 2 min read

A Boon & Ground Breaking Development for the Patients with Severe Acute Stroke.

Stroke is a life-threatening and disabling disease. In the last few years, a lot of research has shown encouraging results in treating patients with acute stroke. Out of these, Endovascular Mechanical Thrombectomy, by far, has shown the most promising results. Mechanical Thrombectomy has made a massive difference in the outcome of patients with severe brain stroke or, in scientific terms, patients with acute large blood vessel occlusion in the brain.

In 2015, five major studies published in the renowned journal of New England Journal of Medicine (NEJM) showed the significant benefit of Mechanical Thrombectomy in patients with severe stroke. These patients otherwise have very poor outcomes, with a risk of lifelong disability, and some may eventually die. To achieve a good result, these patients should get timely care in the hospital with facilities for Mechanical Thrombectomy. Treatment of these patients should ideally start within 6 hours of the symptoms' onset to avoid ongoing brain damage. In 2018 two other major studies published in NEJM showed the benefit of Mechanical Thrombectomy in select stroke patients, even up to 24 hours.

Mechanical Thrombectomy is a procedure in which a tiny tube is taken from the leg blood vessel up to the blocked blood vessel inside the brain. This blocked blood vessel is opened by removing the clot, either with the help of a stent or aspiration of the clot or by using both simultaneously. No incision or open surgery is done in the process of Mechanical Thrombectomy. Mechanical Thrombectomy procedure is performed in the Neuro-Cath lab. Ongoing development and improvement in the hardware used for Mechanical Thrombectomy have increased this procedure's safety and success rate. Now more complex cases are also amenable to this treatment.

The major challenge and hindrance to providing Mechanical Thrombectomy to the larger population is the lack of general awareness regarding Mechanical Thrombectomy and the significance of timely treatment in patients who have suffered the stroke. Another obstacle in providing this treatment to the larger population is the unavailability of facilities for mechanical Thrombectomy in the majority of tier-two cities in India and the cost of hardware (stents and catheters) used in the Mechanical Thrombectomy.

Spreading awareness about getting treatment on time and the procedure of Mechanical Thrombectomy is of utmost importance to save the life and disability of a stroke patient. Costly hardware is another major challenge, especially in a country like India. The way ahead is either subsidizing this hardware used in Mechanical Thrombectomy or capping the hardware by the government or increasing the number of people having medical insurance, or maybe a combination of all of these.

There is a long way to go when many patients who are candidates for Mechanical Thrombectomy get timely treatment. It requires a combined effort from healthcare providers, the government and possibly NGOs.