2023-11-20 09:30:00
Health
By Redação Minuto SaudávelPublished on: 11/20/2023Last update: 11/20/2023
By Minuto Saudável Editorial
Published on: 11/20/2023Last updated: 11/20/2023
Mechanical thrombectomy is now an essential component in reperfusion protocols, playing a crucial role in the early stages of ischemic stroke, especially during the first hours after symptom onset.
Treatment through mechanical thrombectomy appears as an option in serious situations of AVCstanding out for the positive impacts it provides on the clinical management of these cases.
This procedure not only proves to be safe but also presents results that demonstrate its substantial benefit, particularly when we consider the reality of the Unified Health System (SUS).
When used in patients facing severe ischemic stroke, mechanical thrombectomy reveals a significant reduction in mortality rates and length of stay.
Furthermore, surgical intervention offers greater chances of an effective recovery in the post-stroke period, thus representing a considerable advance in the treatment of this condition.
Recent studies highlight the effectiveness of mechanical thrombectomy when comparing it with intravenous thrombolysis, indicating that 46% of patients undergoing this new technique achieved functional independence after three months of treatment.
In December 2021, the National Commission for the Incorporation of New Technologies into the Unified Health System (CONITEC) approved the incorporation of mechanical thrombectomy as a validated technique.
Until that date, the only clinical therapy option available in the public network was thrombolysis, however, this alternative was not always effective in more serious cases.
Approval by CONITEC marks a significant milestone in the provision of treatments for stroke in the context of the SUS. Follow the text to learn more about this technique!
Index:
What is mechanical thrombectomy?When is mechanical thrombectomy indicated?What is ischemic stroke?How is the procedure performed?What are the risks?
What is mechanical thrombectomy?
Mechanical thrombectomy is an innovative surgical procedure designed to unblock and restore cerebral arterial blood flow.
This technique is performed using catheters expertly directed to guide a special device to the blood vessel compromised by the obstruction resulting from clots.
To date, mechanical thrombectomy is not the standard approach for all cases of ischemic stroke. It is recommended selectively, being especially indicated in scenarios where there is occlusion of a large cerebral artery.
In these specific cases, the intervention aims to precisely remove the clot, aiming for immediate restoration of blood flow.
When is mechanical thrombectomy indicated?
The mechanical thrombectomy procedure is currently an integral part of reperfusion treatments, extremely important in the acute phases of ischemic stroke, more specifically in the first hours after the onset of symptoms.
In this context, the speed of taking the patient to a properly equipped hospital, equipped with resources such as tomography and specialized teams in neurology and radio intervention, becomes essential.
Several criteria are considered for the inclusion of endovascular treatment, which are essential to determine the feasibility and effectiveness of mechanical thrombectomy.
These criteria cover the patient’s age, establishing that the patient is greater than or equal to 18 years old, the time elapsed since the onset of symptoms, limited to up to 8 hours.
The presence of occlusion of the internal carotid artery up to the proximal segment of the middle cerebral artery (MCA) is another determining element for the indication of mechanical thrombectomy.
What is ischemic stroke?
Ischemic stroke (ischemic stroke) is a syndrome characterized by an acute focal neurological deficit, resulting from a vascular disorder that compromises the brain tissue. There are two main types of stroke: ischemic and hemorrhagic.
Stroke (ischemic) occurs when there is interruption of blood flow in a cerebral vessel, leading to ischemia in the area irrigated by that specific vessel. This form of stroke is more prevalent, accounting for up to 85% of all cases.
Vascular obstruction in ischemic stroke reduces perfusion and nutrient supply, resulting in hypoxia and, therefore, cell death. Treatment aims to restore blood circulation by recanalizing the obstructed vessel.
In contrast, hemorrhagic stroke usually originates from a lesion in the cerebral vessel, such as an aneurysm, hypertension or cerebral arteriovenous malformation.
This form has a higher mortality rate compared to ischemic stroke, due to the severity of the injury and intracerebral blood loss.
In Brazil, in 2020, 22,100 hospitalizations and 3,388 deaths resulting from ischemic stroke were recorded. The mortality rate reached 15.33%.
Incorporating procedures, such as mechanical thrombectomy, into patient treatment can provide a significant improvement in quality of life, promote greater independence and reduce neurological deterioration.
Read more: Ischemic and hemorrhagic stroke: what it is, causes and sequelae
How is the procedure performed?
Currently, the recommendation to perform thrombectomy extends to situations in which the patient is seen within an interval of up to eight hours after the onset of ischemic stroke symptoms.
Remembering that this surgical approach aims to restore compromised cerebral blood flow, so time is a decisive factor. Extremely critical to optimize the effectiveness of the procedure, taking advantage of the window of opportunity to intervene and minimize the impact of the cerebrovascular event.
Generally, the surgery lasts around 30 minutes. However, due to the complexity of the surgery and each case being different, the patient’s anatomical particularities can significantly influence the time required to perform the thrombectomy.
The mechanical thrombectomy process begins with an incision in the groin region, where the surgeon skillfully uses catheters to guide a device to the blood vessel affected by the obstruction caused by the clot.
The devices used during the procedure include a removable self-expandable stent, which integrates with the clot, facilitating its extraction, and an aspiration system that removes the clot, unblocking the artery.
To precisely maneuver the catheter to the exact location, the surgeon uses a specialized X-ray to monitor the position of the catheter in real time.
The selection of clinical criteria for carrying out the procedure is based on imbalances identified through imaging exams or the assessment of neurological deficit using the scale of impairment caused by the stroke.
This surgical technique is recent and has become an essential tool in the restoration of compromised brain function, standing out as a precise and effective intervention for selected cases, resulting in potential significant improvements in the recovery of the affected person.
Read more: Catheterization: what is it for? Who needs to do it?
What are the risks?
According to the National Stroke Research Network, linked to the Research and Innovation Coordination of the Secretariat of Science, Technology and Strategic Inputs of the Ministry of Health, mechanical thrombectomy does not present additional risks compared to other conventional treatments.
Furthermore, it is noteworthy that this procedure offers additional benefits, especially with regard to the effectiveness of treatment in patients facing an acute ischemic stroke.
Cerebral Vascular Accident (CVA) is a disease with a high potential for mortality and is worrying in terms of the risk of functional disability. Strokes of ischemic origin occupy a significant proportion, benefiting from several treatment options.
In this scenario, there is an act focused on technological improvement aimed at the use of mechanical thrombectomy in cases of ischemic stroke.
Specific treatment for stroke can encompass a variety of therapeutic approaches, including the use of medications designed to dissolve blood clots, such as thrombolytics, and drugs designed to decrease the propensity for blood to clot, such as antiplatelet agents and anticoagulants.
However, when it comes to surgical treatments for ischemic stroke cases, mechanical thrombectomy is currently the main choice.
In this procedure, blood clots are physically removed from the arteries, seeking to restore blood flow and reduce damage caused by cerebral ischemia.
The combination of therapeutic strategies, adapted to the specific needs of each patient, contributes to a comprehensive and optimized treatment, aiming to improve clinical results and promote functional recovery after a stroke episode.
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