Endovascular Stroke Therapy

Endovascular Stroke therapy is a new method for treating stroke that was approved by the FDA in August 2004. With this method, a catheter is inserted into an artery in the groin and threaded through the body into the site of the blood clot in the brain. A corkscrew-like device, which is threaded 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 is administered intravenously, and it can only be used within three hours of the onset of stroke symptoms. There is a small window of opportunity for the intravenous usage, and it’s not safe for all stroke victims. Currently intravenous tPA is only used in 3% of stroke cases. Intra-arterial administration of tPA can be utilized up to 6 hours after the onset of symptoms, because the delivery of drug is directly into the clot.

Endovascular stroke therapy can be used up to eight hours after a stroke onset and 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.

The approval of 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.

This page contains the following information about stroke therapy:

Reasons Stroke Therapy Is Performed

Stroke therapy may be performed instead of administering intravenous tPA for the following reasons:

Stroke therapy can only be used if the blood clot is visible through imaging techniques such as angiography or CT scan.

Risks Involved in Stroke Therapy

Since a catheter is placed within the blood vessels, there is a risk of damage to a blood vessel, bruising or bleeding at the puncture site, or infection.

You could have an allergic reaction to the contrast material used during the procedure.

It is possible for fragments of the blood clot to 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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Procedure Locations

Stroke therapy is an emergency procedure that is performed by INVISION radiologists at the following INVISION partner hospitals:

Please note:

INVISION is partially owned by Radiology Imaging Associates (RIA); consequently, your radiologist’s lab coat and your bill, if you receive one, will say RIA rather than INVISION.

What Happens During Stroke Therapy

A fluoroscope is used during stroke therapy to allow the radiologist to see the movement of the catheter within the body and brain. The fluoroscope will be moved into position over the abdomen and head.

After making a small incision at the groin, the radiologist will thread a catheter into the femoral artery. While watching the fluoroscope images on a computer screen, the radiologist will steer the catheter through the arteries until it reaches the artery in the neck. At this point, 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 deploy the snare. The snare automatically coils into the shape of a corkscrew as it’s released. The corkscrew is then gently pulled backward into the clot to trap it.

At this point, a balloon is 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. The micro-catheter and snare are withdrawn into the guiding catheter in the neck, pulling the clot with them. When the clot is removed from the body, the balloon is then deflated and the guiding catheter is withdrawn. The groin incision is cleaned and taped.

After the procedure, additional images will be taken with angiography, CT scan or MRI to check blood flow to the affected area of the brain.

Additional Information

The information on this page was taken in part from some of the following web sites. Visit these sites for additional information on stroke therapy.

Sources

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