World Stroke Day
Mechanical Thrombectomy: An ischemic stroke therapy
Stroke is the third leading cause of death in Bangladesh. In developed countries, Alteplase or rtPA (recombinant tissue plasminogen activator) injection is pushed into the patient's vein within 4.5 hours from the onset of stroke symptoms. Now some public and private hospitals in Bangladesh have successfully started intravenous thrombolysis (IV thrombolysis).But suppose the patient comes to the hospital after 4.5 hours or not indicated for IV thrombolysis therapy, in that case, it is recommended to use the procedure of endovascular stent aspiration or Mechanical Thrombectomy. This procedure is also beneficial for those patients when large clots have not entirely been dissolved by clot busting drug injection.
Let us see the entire procedure through a hypothetical case - a patient tries to get off the bed in the morning but notice that he could not do it. There is weakness in his right hand and leg. He tries to call for help but only able to utter incomprehensible words. Afterward, while trying to get off his bed again, he fell and was rushed to the emergency.
Note that, an ischemic stroke usually happens when a blood clot blocks the brain artery. He reached the emergency department (ED) within the 2 hours of the symptom's onset. By that time, he has already developed a mild to moderate weakness at the right side of the body and the inability to speak coherently. The patient was diagnosed with a stroke, and his Computed tomography (CT) scan showed ischemic stroke, and CT angiogram showed partial occlusion of the left middle cerebral artery by thrombus. Afterward, the medicine called alteplase was given through an intravenous route within 3 hours of symptoms onset. After 20 minutes of bolus injection, the patient moved his right upper limb; however, the condition again deteriorated after 5 hours. He developed complete weakness on the right side of the body along with difficulty in speaking.
The patient was then rushed to a neuro intervention Cath Lab for removal of clot from blocked vessel, called Mechanical Thrombectomy (MT).
In the Cath lab,the patient's brain vessels were evaluated using angiography technique and found that one large blood vessel which supply blood to the left part of brain was narrowed and distally occluded. A small tube over a wire is placed into the occluded segment and then a clot retriever was deployed there. After 5 minutes of waiting the clot retriever was pulled out, which took out the clot from blocked vessel and brain started receiving blood in the previously blocked segment. The entire procedure was successful.
The government should modernize the existing Cardiac Cath labs of the tertiary district hospitals and provide expert training to the medical personnel. The initiative will give acute stroke therapy to the mass population.
Mechanical Thrombectomy will be a promising therapeutic option for acute stroke treatment in the future. We hope this will increase awareness about stroke among masses which will encourage people of Bangladesh to seek stroke treatment on time.
Dr. Sirajee Shafiqul Islam, Associate Professor, Interventional Neurology, National Institute of Neurosciences and Hospital