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Mechanical Thrombectomy

Mechanical thrombectomy (MT) is a procedure performed in the setting of an acute ischaemic stroke. The operator gains access to the cerebral circulation usually via the femoral artery in the groin and gains access to the cerebral circulation. Using specialised kit the operator can remove an occlusive thrombus from the proxmal MCA. The clot is aspirated into the device and removed. This allows flow to be recommenced in the obstructed artery. The goal of thrombectomy is to achieve a complete recanalization (TIMI grade, 3). It may also be used on other large vessel occlusions such as Basilar artery thrombi. Mechanical treatment approaches for acute ischaemic stroke treatment aim for fast and efficient reperfusion with short procedure times and high recanalisation rates, thus extending the treatment window. MT may be used with or instead of IV Alteplase.

Technically there are two different approaches - proximal thrombecotmy which is done by using an aspiration catheter to retrieve the thrombus under constant negative pressure. This has been sued in the distal cervical internal carotid artery, the carotid terminus or the basilar artery. Recanalisation rates are approximately 80% with good clinical outcomes [11]. One system used is the Penumbra System (Penumbra, Almeda, USA) which rather than manual aspiration has a dedicated reperfusion catheter connected to a pumping system applying continuous aspiration.

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