Acute Ischemic Stroke (AIS) refers to a sudden interruption of blood flow to the brain, resulting in brain cell damage and possibly death. According to the World Health Organization (WHO), stroke is the third leading cause of death globally, with about 15 million people suffering from stroke annually. AIS remains a significant challenge in healthcare worldwide. Traditionally, the treatment of AIS has been limited to conservative management, including medical therapy such as thrombolytic agents, anticoagulation, and supportive care. These interventions aim to limit the extent of brain injury, improve recovery, and prevent further complications.
However, technological advancements have revolutionized the management of AIS. Mechanical thrombectomy has become an essential treatment modality in patients with AIS caused by large vessel occlusion (LVO). The use of clot retrieval devices, including aspiration catheter and stent retrievers, has improved the outcome of patients with AIS and extended the therapeutic time window. This essay aims to discuss the benefits of using the combination of aspiration catheter and stent retrievers in AIS clot retrieval and its impact on patient outcomes.
Aspiration Clot Retrieval:
Aspiration thrombectomy involves the use of a catheter and a suction device to remove the clot directly from the occluded vessel. The retrieval of clots using aspiration catheter is a minimally invasive technique that can reverse ischemic damage and restore cerebral blood flow. The technique involves placing a catheter in the proximal part of the clot, which is then connected to a suction device. The catheter is advanced until it reaches the thrombus, and the clot is withdrawn using negative pressure. Aspiration catheter thrombectomy is highly effective in younger patients with acute LVO because it results in rapid recanalization, decreases the incidence of distal embolism, and reduces the complication rate. Additionally, it is suitable for patients with contraindications to thrombolytic agents, such as those with recent surgeries, hemorrhagic stroke, or anticoagulant therapy.
Stent Retrieval:
Stent retrievers are catheter-based devices that mechanically retrieve the clot from the occluded vessel. The stent retriever technique involves advancing a microcatheter beyond the clot and deploying the stent retrieval to encircle the thrombus. The stent retriever device is then gently withdrawn, along with the clot, restoring the antegrade cerebral blood flow. The stent retriever technique has several advantages, such as a high recanalization rate, low complication rate, and aiding the detection of the appropriate clot location. The use of stent retrievers is particularly helpful in patients who have failed previous thrombiectomy or thrombolytic agents. Moreover, it can be used for the retrieval of distal embolization, which occurs when fragments of the clot break and migrate distally.
Combination of the Aspiration and Stent Retrieval:
The combination of the aspiration and stent retriever technique has revolutionized the management of AIS clot retrieval. The combined approach allows for maximal clot retrieval by combining both techniques' strengths. The technique involves using a combination of high aspiration and a stent retriever to extract the clot. First, the aspiration technique is used to isolate the clot, and then the stent retriever is inserted to ensnare the thrombus. The combination of these techniques has several advantages over using one technique alone. The use of aspiration before stent retrieval can aid in locating the thrombus, which allows for a quicker and more efficient recanalization. Moreover, the combination technique can reduce the need for rescue thrombectomy or additional interventions and results in a higher rate of successful reperfusion. In addition, it can help minimize the damage to the vessel during retrieval, resulting in reduced costs and shorter hospital stays.
Impact on Patient Outcomes:
The use of the combination of aspiration and stent retriever techniques in AIS clot retrieval has been a game-changer in medical field. The technique has a significant impact on patient outcomes, including reduced disability, an improved quality of life, and a reduced need for institutionalized care. Numerous studies have demonstrated the superiority of the combination technique over traditional medical therapy alone or isolated stent retriever or aspiration techniques. These studies report better functional outcomes, higher rates of successful recanalization, and lower mortality rates in patients treated with the combined approach. Moreover, the technique is efficacious within a longer therapeutic time window, enabling a broader range of patients to receive benefits from mechanical thrombectomy.
Conclusion:
The combination of the aspiration and stent retriever techniques for AIS clot retrieval has brought about a paradigm shift in the management of AIS. The technique results in more successful reperfusion, shorter hospital stays, reduced morbidity and mortality, and improved patient satisfaction. Proper patient selection, an experienced team, and efficient systems are essential for achieving optimal clinical outcomes. The combined approach to AIS clot retrieval using aspiration and stent retriever has indeed been a game-changer in medical field.