Stroke Thrombectomy
Date issued: October 2023
Review date: October 2025
Ref: A-593/JHF/Radiology/Stroke Thrombectomy
PDF: Stroke thrombectomy final October 2023.pdf [pdf] 225KB
This leaflet tells you about stroke thrombectomy. It explains what is involved, the potential benefits and the possible risks. It is not meant to replace informed discussion between you and your doctor but can act as a starting point. If you think of any questions, please ask the doctor who referred you or the doctor who will be doing the procedure.
Referral and consent
It is important that you feel involved in decisions about your care. You or your next of kin may be asked to sign a consent form for this treatment. In an emergency, if you are too unwell, it may go ahead with your best interests in mind. You can withdraw your consent at any time, even if you have said ‘yes’ previously. If you would like more details about our consent process, please ask for a copy of our policy.
Referral and consent
A stroke thrombectomy is an emergency treatment to remove a blood clot which is reducing or obstructing blood flow and oxygen supply to the brain.
Why do you need a stroke thrombectomy?
Some injury may have already occurred by the time you reach hospital, but restoring blood flow and oxygen supply gives the best chance of preventing any further injury to the brain and gives the best chance of recovery. If left untreated, this may result in a more disabling stroke, including weakness affecting the arm, leg or face, speech difficulties, visual impairment, or other disability.
For the 1 in 10 patients who have stroke symptoms and are suitable for this treatment, it is a very powerful intervention in removing clots which are too big to be broken down by clot-busting drugs.
Are there any risks?
Thrombectomy does not pose any greater risk of complications compared to other types of stroke treatment.
Complications that are rare but serious can include:
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Restoring blood flow to injured brain or damage to the artery when removing the clot can lead to bleeding into or around the brain. This can be serious and may even lead to death.
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The blood clot may be dislodged and move deeper or into a new blood vessel causing injury there.
Less serious complications include:
Bruising or bleeding at the top of the leg or wrist where the catheter (thin plastic tubing) is inserted. In very rare cases, this can require further surgery.
Kidney damage or allergic reactions are very rare complications relating to the procedure.
The procedure also involves using x-rays for guidance. If you are pregnant or suspect that you may be pregnant you should let us know and may be asked to sign a form. Any exposure to x-rays has the potential to cause cancer later in life but the risk is extremely low, far lower than the risk we all have of developing cancer in our life.
For information about the effects of X-rays read the publication: “X-rays how safe are they” on the Health Protection Agency website: www.hpa.org.uk
Small risks related to the anaesthetic can be explained to you by your anaesthetist.
What are the alternatives?
Other treatments include rehabilitation therapies and taking medicines designed to dissolve the blood clot.
Without stroke thrombectomy, on average 1 in 4 patients will regain independence.
With stroke thrombectomy and other treatments combined, 1 in 2 patients will regain independence.
Who will you see?
The stroke team, anaesthetic team and radiology team led by a neurointerventional radiologist. Neurointerventional radiologists have expertise using image guided techniques to aid diagnosis and treatment of stroke.
Where will the procedure take place?
In the interventional suite, which is located within the radiology department. This is similar to an operating theatre into which specialised x-ray equipment has been installed.
What happens during a stroke thrombectomy?
Before the procedure, the neurointerventional radiologist will explain the procedure and ask you to sign a consent form. Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
Generally, a stroke thrombectomy is performed under general anaesthetic with you asleep. It may be performed with sedation; you are awake but won’t feel pain.
This procedure is performed under sterile conditions. The neurointerventional radiologist and nurse will wear sterile gowns and gloves to carry out the procedure.
Whilst under anaesthetic, a urinary catheter may be placed in your bladder, as you will need to stay in bed for a few hours once the procedure is over.
Your skin at the top of the leg or your wrist will be swabbed with antiseptic and sterile drapes will be laid over you.
Using X-ray guidance, a small needle followed by a wire and catheter (fine plastic tube) will be inserted into your blood vessel and guided to the blocked blood vessel. The clot is then removed using specialist equipment.
When the procedure has finished, all equipment will be removed. A stitch may be used to close the small hole in the blood vessel or firm pressure will be applied to prevent any bleeding.
Will it hurt?
You may experience a small amount of discomfort in your groin, wrist or head, but most patients do not remember this.
How long will it take?
Every patient's situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be, however, on average the anaesthetic and procedure can take one to two hours.
What happens afterwards?
You will be transferred to a recovery ward to recover from the anaesthetic. From there, you will most likely go to the Stroke Unit in Merrivale ward where you will be monitored closely by the Stroke team. If you are not local to Plymouth, you will usually be transferred back to your local Stroke Unit the following day.
Finally
We hope that this guide will have answered any questions you may have about the procedure. However, you are free to ask the stroke team looking after you anything you are unsure about.
Contact
Interventional Radiology Department
01752 437468, 01752 432063 or 01752 430838
Merrivale ward
01752 432234 or 01752 32859
Visiting hours: 2pm to 7pm
Protected mealtimes: Midday to 1pm and 5.30pm to 6.30pm
Additional Information
Bus services:
There are regular bus services to Derriford Hospital. Please contact:
www.citybus.co.uk
www.targettravel.co.uk
www.stagecoachbus.com
www.travelinesw.com
Car parking:
Hospital car parking is available to all patients and visitors. Spaces are limited so please allow plenty of time to locate a car parking space. A charge is payable.
