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thrombectomy
Indications:
- venous thrombosis
- deep vein thrombosis
- pulmonary embolism
- arterial thrombosis
- acute stroke, large vessel within 6 hours or radiographic mismatch within 6-24 hours [3]*
- complicated PCI for STEMI
- thrombosed arteriovenous fistula
* a small infarct core & greater amount of tissue at risk [3]
Contraindications:
- Not routinely indicated with PCI for STEMI [2]
Benefit/risk:
- patients with large cerebral infarctions have better functional outcomes with endovascular thrombectomy than with medical care alone but have more intracranial hemorrhages
Procedure:
- removal of a thrombus; distinguish from thrombolysis
- adjunct intra-arterial alteplase following successful thrombectomy of large vessel occlusion acute ischemic stroke results in increased likelihood of favorable neurological outcomes [4]
Radiology:
- computed tomography suggesting a small infarct core & greater amount of tissue at risk (radiologic mismatch) [3]
Specific
arterial thrombectomy
arteriovenous thrombectomy
venous thrombectomy
General
vascular surgery
surgical resection (excision)
References
- Stedman's Medical Dictionary 27th ed, Williams &
Wilkins, Baltimore, 19992
- 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
- Nogueira RG, Jadhav AP, Haussen DC et al
Thrombectomy 6 to 24 hours after stroke with a mismatch between
deficit and infarct.
N Engl J Med 2017 Nov 11;
PMID: 29129157 Free Article
- Hacke W.
A new DAWN for imaging-based selection in the treatment of
acute stroke.
N Engl J Med 2017 Nov 11
PMID: 29129127 Free Article
- Renu A, Millan M, San Roman L et al
Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on
Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke.
The CHOICE Randomized Clinical Trial.
JAMA. 2022;327(9):826-835
PMID: 35143603 PMCID: PMC8832304 (available on 2022-08-10)
https://jamanetwork.com/journals/jama/fullarticle/2789098
- Yoshimura S, Sakai N, Yamagami H et al.
Endovascular therapy for acute stroke with a large ischemic region.
N Engl J Med 2022 Feb 9; [e-pub].
PMID: 35138767
https://www.nejm.org/doi/10.1056/NEJMoa2118191
- Wikipedia: Pulmonary thrombectomy
http://en.wikipedia.org/wiki/Pulmonary_thrombectomy
- AngioJet Mechanical Thrombectomy
http://www.dvtanswers.com/Treatments/thrombectomy.html
- Drexel Cardiology - Thrombectomy
http://www.drexelmed.edu/Home/DrexelUniversityPhysicians/MedicalPractices/Cardiology/Treatments/Thrombectomy.aspx