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arterial thrombectomy

Indications: - arterial thrombosis - *complicated PCI for STEMI - for up to 24 hours after symptom onset in eligible patients with ischemic stroke* [3] - within 6-16 hours of anterior-circulation large-vessel occlusion [8] - Trevo clot retrieval device FDA-approved [4] * anterior circulation large-vessel occlusion * see endovascular thrombectomy for acute ischemic stroke Procedure: - CT angiography to determine eligibility for arterial thrombectomy [7] - tPA received within 4.5 hours of symptom onset - no advantage of tPA prior to thrombectomy [6,9] - tenecteplase before thrombectomy superior to alteplase [5] - aspiration-assisted stent retrieval* - aspiration thrombectomy* * aspiration does not require a catheter to pass through a clot, reducing risk of distal emboli during the procedure [2] Contraindications: - Not routinely indicated with PCI for STEMI [1]

Specific

endovascular thrombectomy for acute ischemic stroke peripheral arterial thrombectomy

General

thrombectomy

References

  1. Kaltoft A et al, Routine thrombectomy in percutaneous coronary intervention for acute ST-segment-elevation myocardial infarction: a randomized, controlled trial. J Am Coll Cardiol 2006, 48:244 PMID: 16801464 - Ali A et al, for the AIMI Investigators Rheolytic thrombectomy with percutaneous coronary intervention for infarct size reduction in acute myocardial infarction: 30-day results from a multicenter randomized study. J Am Coll Cardiol 2006, 48:244 PMID: 16843170
  2. Dippel DWJ Thrombectomy Options for Acute Ischemic Stroke. Which Way to Go? JAMA Neurol. Published online Jan 2, 2018. PMID: 29297050 https://jamanetwork.com/journals/jamaneurology/article-abstract/2666951
  3. Powers WJ, Rabinstein AA, Ackerson T et al 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018; Jan 24 PMID: 29367334 http://stroke.ahajournals.org/content/early/2018/01/23/STR.0000000000000158 - Furie KL, Jayaraman MV 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. PMID: 29367335 http://stroke.ahajournals.org/content/early/2018/01/24/STROKEAHA.118.020176
  4. FDA News Release. Feb 15, 2018 FDA expands treatment window for use of clot retrieval devices in certain stroke patients. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm596983.htm
  5. Campbell BCV, Mitchell PJ, Churilov L et al Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. N Engl J Med 2018; 378:1573-1582 PMID: 29694815 http://www.nejm.org/doi/full/10.1056/NEJMoa1716405
  6. Coutinho JM et al. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke: A pooled analysis of the SWIFT and STAR studies. JAMA Neurol 2017 Jan 9 PMID: 28097310
  7. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
  8. Powers WJ, Rabinstein AA, Ackerson T et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 Update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke 2019 Dec; 50:e344. PMID: 31662037 https://www.ahajournals.org/doi/10.1161/STR.0000000000000211
  9. Yang P, Zhang Y, Zhang L et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. PMID: 32374959 N Engl J Med 2020 May 21; 382:1981 https://www.nejm.org/doi/10.1056/NEJMoa2001123
  10. Lapergue B, Blanc R, Costalat V et al Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion. The ASTER2 Randomized Clinical Trial. JAMA. 2021;326(12):1158-1169. September 28. PMID: 34581737 https://jamanetwork.com/journals/jama/fullarticle/2784507