Who should not undergo a clot removal procedure?
You should not undergo a clot removal procedure if you are eligible for the first-choice stroke treatment of tPA or if you have had a stroke caused by bleeding in the brain ( hemorrhagic stroke). You should also not have the procedure if you are allergic to the dye used in the procedure or if the blocked artery has lots of twists and bends, which can make it difficult to guide the device to the blood clot.
What are the risks of the procedure?
The risks of this procedure are similar to those of other procedures in which a catheter is inserted into your blood vessels. The device could break off a clot that could block another artery in the brain or elsewhere in the body, or the catheter or wire used to deliver the device could tear a hole in the blood vessel wall, possibly causing a bleeding stroke or death. There is also a risk of bleeding in the brain, which happens in about 10% of patients.6, 7 The incision where the catheter was inserted can also result in bleeding problems.
References
- Smith WS, Sung G, Starkman S, et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke. Jul 2005;36(7):1432-1438.
- Adams HP, Jr., del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. May 2007;38(5):1655-1711.
- Macdougall C, Clark W, Mayer T, et al. The Penumbra Stroke Trial: Safety and Effectiveness of a New Generation of Mechanical Devices for Clot Removal in Acute Ischemic Stroke. Paper presented at: American Stroke Association International Stroke Conference, 2008; New Orleans, LA.
- Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. Jan 29 2008;117(4):e25-146.
- Flint AC, Duckwiler GR, Budzik RF, Liebeskind DS, Smith WS. Mechanical thrombectomy of intracranial internal carotid occlusion: pooled results of the MERCI and Multi MERCI Part I trials. Stroke. Apr 2007;38(4):1274-1280.
- Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke. Results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I. Am J Neuroradiol. Jun-Jul 2006;27(6):1177-1182.
- Smith WS, Sung G, Saver J, et al. Mechanical Thrombectomy for Acute Ischemic Stroke: Final Results of the Multi MERCI Trial. Stroke. April 1, 2008 2008;39(4):1205-1212.
