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What are the Risks and Benefits of Endovascular Treatment for an Ischemic Stroke
Endovascular treatments are procedures that can be used to remove a blood clot that is blocking blood flow to the brain (ischemic stroke). These treatments involve inserting a thin, flexible tube (catheter) into an artery and up to the blood clot. After the catheter is inserted, there are two types of endovascular treatments that may be used:
- Mechanical thrombectomy. During this treatment, a small, wire-cage device (stent retriever) is threaded through the catheter. The stent opens up and grabs the blood clot. Then the stent and clot are removed. Other devices that use a suction technique may also be used.
- Intra-arterial TPA. During this treatment, a medicine to dissolve the clot (tissue plasminogen activator, or TPA)is sent through the catheter directly to the clot.
Endovascular treatment is sometimes used in combination with giving TPA through an IV, which is the most common treatment for ischemic stroke. An ischemic stroke is a medical emergency. Treatments need to be done as soon as possible to give you the best chance for recovery.
Are endovascular treatments an option for me?
Your health care team will work quickly to determine your treatment options. Endovascular treatments are very effective for certain types of stroke, but there are some restrictions for when these treatments can be used. Whether these treatments are an option for you will depend on various factors, such as:
- When your stroke symptoms started.
- The size of the blockage that caused the stroke.
- Your ability to perform normal duties or activities before the stroke.
What are the benefits of mechanical thrombectomy and intra-arterial TPA?
When TPA is given through an IV, it must be done within 3–4½ hours of the first signs of a stroke. Mechanical thrombectomy and intra-arterial TPA can be done beyond that time limit for appropriate patients. These endovascular treatments have other benefits:
- They are more effective at removing clots from large blood vessels.
- They are less likely to cause bleeding in the brain (brain hemorrhage).
- They may result in better recovery after stroke, including fewer brain problems (cognitive problems) and movement problems.
What are the risks of mechanical thrombectomy and intra-arterial TPA?
With these procedures, certain problems can occur, including:
- Bleeding in the brain (brain hemorrhage).
- Damage to blood vessels.
- Bleeding at the site where the catheter was inserted.
- Infection at the site where the catheter was inserted.
What questions should I ask my health care provider?
- Which stroke treatments am I able to have?
- Are there other risks and benefits of this treatment for my situation?
- How will I know if the treatment was successful?
Summary
- Endovascular treatments are procedures to remove a blood clot that is blocking blood flow to the brain (ischemic stroke).
- Mechanical thrombectomy and intra-arterial TPA are two types of endovascular treatment.
- Endovascular treatments involve inserting a thin, flexible tube (catheter) into an artery and up to the blood clot. After the catheter is inserted, a device is used to remove the clot or a medicine is injected to destroy the clot.
- Endovascular treatments extend the time window for treatment for stroke patients and may result in better recovery.