Endovascular Stroke Therapy

General Information | Scheduling, Insurance and Preparation | What to Expect


General information General Information

About Endovascular Stroke Therapy

Endovascular stroke therapy can be used up to eight hours after a stroke onset and can restore blood flow within minutes.

Endovascular Stroke therapy is a newer method for treating stroke that was approved by the FDA in August 2004. With this method, a long tube called a catheter is inserted into an artery in the groin. The catheter is guided through the blood vessels to the site of the blood clot in the brain. A corkscrew-like device, which is passed through the catheter, is then used to trap the clot and physically withdraw it from the brain.

The other FDA approved method for treating stroke is a clot dissolving drug called tissue plasminogen activator (tPA). This drug can be administered intravenously within three hours of the onset of stroke symptoms. This is a small window of opportunity and this drug is not safe for all stroke victims.

tPA can also be administered from within the artery directly into the clot. When administered this way, it can be utilized up to six hours after the onset of stroke symptoms.

Endovascular stroke therapy can be used up to eight hours after a stroke onset as long as the blood clot is visible through imaging techniques such as angiography or CT scan. This technique can restore blood flow within minutes. In clinical trials, endovascular stroke therapy was able to restore blood flow in 54% of patients. Thirty-seven percent of those treated with stroke therapy recovered with no or only minor disability.

Endovascular stroke therapy offers a promising new method for treating stroke that can be used alone or in conjunction with intravenous tPA. It provides a treatment alternative that can be utilized under circumstances where intravenous tPA cannot.

Risks Involved in Endovascular Stroke Therapy

Following are some of the risks associated with this procedure:

  • Damage to a blood vessel
  • Bruising, bleeding, or infection at the puncture site
  • Allergic reaction to the contrast material used during the procedure
  • Fragments of the blood clot could break off, travel downstream, and lodge in smaller blood vessels. Intravenous tPA may be used in conjunction with endovascular stroke therapy to dissolve or remove potential blood clot fragments.

Stroke therapy does not guarantee the reversal of stroke symptoms, or even survival. Twenty-five percent of stroke victims that undergo this procedure still die.

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Scheduling, Insurance and Preparation Scheduling, Insurance and Preparation

Procedure Locations

Endovascular stroke therapy is an emergency procedure that is performed by the Neurointerventional Surgeons at Swedish Medical Center. As a comprehensive stroke center, Swedish Hospital serves as the major hub in Colorado stroke care receiving patients from a five state region via telemedicine for consideration of intravenous medication and/or surgery to open up the blood vessel. It is our goal to provide fast, effective treatment to all stroke patients.

Insurance Coverage

Emergency procedures are usually covered by insurance. Contact your insurance company to check your coverage for this procedure and emergency room visits.

Conditions to Let Us Know About

There are no conditions to let us know about since endovascular stroke therapy is done under emergency circumstances.

Preparation Guidelines

There are no preparation guidelines for endovascular stroke therapy since it is done under emergency circumstances.

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What to Expect What to Expect

During the Procedure

A fluoroscope, a machine that takes real-time x-rays, is used during stroke therapy to allow the radiologist to see the movement of the catheter within the brain.

Here is generally what will happen during an endovascular stroke therapy procedure:

  1. A technologist will start an intravenous (IV) line in your arm. He or she will set up various devices so your heart rate and blood pressure can be monitored throughout the procedure.
  2. An anesthesiologist may administer general anesthesia so you will sleep during the procedure.
  3. The site of the groin incision will be cleansed.
  4. A fluoroscope will be moved into position above the abdomen and head.
  5. The groin incision will be made and the catheter will be inserted into the femoral artery. Using the fluoroscope images, the radiologist will carefully guide the catheter into the carotid artery in the neck.
  6. A micro-catheter (a very tiny tube) will be advanced through the original catheter to the site of the blood clot. After the micro-catheter is pushed through the blood clot, the radiologist will release the snare. The snare automatically coils into the shape of a corkscrew as it’s released.
  7. The corkscrew will be gently pulled backward into the clot to trap it.
  8. A balloon will be inflated from the original catheter in the carotid artery in the neck. This temporarily stops blood flow so moving blood cannot dislodge the clot from the corkscrew.
  9. The micro-catheter and snare are withdrawn into the guiding catheter in the neck, pulling the clot with them.
  10. When the clot is removed from the body, the balloon is then deflated and the guiding catheter is withdrawn.
  11. The groin incision cleaned and taped.
  12. Additional images will be taken with angiography, CT scan or MRI to check blood flow to the affected area of the brain.

After the Procedure

Follow-Up

It is very important that you go to all follow-up appointments requested by your treating physician.

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