Thrombectomy

A thrombectomy is a surgical procedure that removes blood clots from blood vessels, restoring blood flow to vital organs and potentially preventing death or serious disability when performed promptly.

Table of contents

• What is a thrombectomy?
• Who needs a thrombectomy?
• Conditions that thrombectomy treats
• Types of thrombectomy procedures
• How the procedure is performed
• Why timing matters
• Risks and benefits
• Recovery and follow-up

What is a thrombectomy?

A thrombectomy is a surgery or minimally invasive procedure to remove a blood clot from a blood vessel, which can be either an artery or vein^[1]. A blood clot, also known as a thrombus (a solid clump of blood that blocks normal blood flow), can interrupt the flow of blood to your body parts and organs, creating situations that can be life-threatening or limb-threatening^[1].

Blood clots most commonly occur in the legs, arms, intestines, brain, lungs, and heart^[1]. The procedure works by removing the clot to help restore normal blood flow through your blood vessels^[1].

A thrombectomy is a mechanical procedure performed under image guidance using specialized devices inserted through blood vessels^[2]. Sometimes the procedure must be performed within a matter of hours to prevent life-threatening or limb-threatening complications from occurring^[1].

Who needs a thrombectomy?

You might need a thrombectomy if you have a blood clot that healthcare providers cannot treat with medications alone^[1]. Not all blood clots require surgical removal. Some blood clots can be treated with medicines like anticoagulants (drugs that thin your blood to prevent more clots from forming) or thrombolytics (drugs that dissolve sudden clots)^[1].

The procedure may help you if the clot blocks blood flow to a part of your body, putting you at risk for death, permanent tissue or organ damage, or embolus (when a blood clot breaks loose from one location and travels to another location in your body)^[1].

You might not be a candidate for a thrombectomy if you have a blood clot in a location that is too hard to reach, a blood clot in a very small blood vessel, a blood clot that can be treated with medication, a pre-existing blood disorder, bleeding in your brain, very high blood pressure that cannot be treated, or a chronic clot that has been present for more than 30 days^[1].

Conditions that thrombectomy treats

A thrombectomy may treat several serious medical conditions, including^[1]:

• Deep vein thrombosis (DVT)
• Acute upper or lower extremity arterial limb ischemia (reduced blood flow to limbs)
• Acute mesenteric ischemia (reduced blood flow to intestines)
• Renal artery occlusion (blocked kidney artery)
• Heart attack (myocardial infarction)
• Pulmonary embolism (blood clot in the lung)
• Stroke

For stroke specifically, about 1 in 10 people with stroke could benefit from thrombectomy^[3]. The procedure is used to treat ischemic stroke (a type of stroke caused by a blocked blood vessel in the brain), which occurs when a blood clot blocks an artery in the brain^[3].

Types of thrombectomy procedures

There are two large categories of thrombectomies^[1]:

Surgical (open) thrombectomy: During a surgical thrombectomy, your surgeon makes an incision to get to your blocked blood vessel, cuts open your blood vessel, removes the blood clot using a balloon, and then repairs the blood vessel^[1].

Percutaneous (minimally invasive) thrombectomy: During a mechanical thrombectomy, your surgeon introduces special devices through thin tubes called catheters (long, flexible tubes) that can either break up or suction out clots from within your blood vessel^[1]. When there is a leftover clot, your surgeon may infuse the area with local clot-dissolving medicines^[1].

Some of the minimally invasive techniques include catheter-directed mechanical thrombectomy with or without clot-dissolving drugs, catheter-directed aspiration thrombectomy, and catheter-directed thrombolysis^[1]. These techniques commonly use stent-retrieval (a device that captures the clot), direct aspiration (suctioning the clot out), or a combination of both^[2].

How the procedure is performed

For the minimally invasive procedure, you may receive medicine to help you sleep or relax into a light sleep^[6]. The doctor places a thin, flexible catheter into a blood vessel in your groin or wrist^[6]. The catheter is then carefully guided through the blood vessels to reach the blocked area^[3].

The catheter may be used to inject a special dye into the blood vessel. This dye allows the doctor to see a picture of the blood vessel on a video screen during the procedure^[6]. The procedure uses continuous X-ray imaging, called fluoroscopy, to guide the instruments through your arteries to the clot^[2].

The catheter is also used to remove the clot. This is done with a tiny tool that fits inside the catheter^[6]. In stroke treatment using a stent retriever, a small net-like device is inserted through the catheter and guided to the blockage. The device is pushed through the clot and then expands to the size of the artery wall, capturing the clot so the surgeon can pull it out^[2].

The entire procedure typically takes between one and two hours to complete, depending on the location and size of the blood clot^[2].

Why timing matters

Thrombectomy should be carried out as soon as possible after symptoms begin^[3]. It is most effective when performed within the first few hours of symptoms starting^[3].

For stroke patients, doctors try to use the procedure within 6 to 24 hours of the stroke^[6]. The American Heart Association and American Stroke Association recommend starting the procedure within 6 hours of symptom onset for most patients^[2]. However, recent studies have shown that mechanical thrombectomy can improve outcomes in select patients with large vessel stroke presenting up to 24 hours after the start of symptoms^[2].

Quick treatment with thrombectomy can make a significant difference to recovery. By removing the blood clot and restoring blood flow, the procedure helps reduce damage to tissues and organs^[3]. In the brain, this means that fewer brain cells die, lowering the chance of serious disability^[3].

Risks and benefits

Benefits: A thrombectomy can greatly reduce the risk of death or permanent disability if performed promptly^[1]. The procedure can improve recovery and lower the risk of death, especially if given as soon as possible after symptoms start^[6]. It can limit damage and loss of body function by removing the blood clot^[6]. In general, the less damage there is to tissues and organs, the less disability occurs, and people are more likely to recover^[6].

Risks: As with any medical procedure, thrombectomy carries some risks^[3]. The risks are mainly related to the procedure itself and may include bleeding where the catheter was inserted, a tear or sudden closure of a blood vessel, blood vessel damage or narrowing, severe bruising called hematomas, infection, and the possibility of a clot shifting from its original location and migrating to the lungs (pulmonary embolism)^[6].

Your doctor should explain these risks and answer any questions before the procedure^[3]. Based on your condition, the doctor will explain what other choices you have for treatment, which may include medicines that dissolve the clot or stop it from getting bigger^[6].

Recovery and follow-up

After the procedure, you will be monitored in the hospital for several days to ensure that there are no complications^[2]. The medical team will provide instructions for recovery and rehabilitation^[2].

Recovery is different for everyone. Some people notice an improvement quickly, while others need more time and support^[3]. Rehabilitation may include physical therapy, occupational therapy, and speech therapy to help you regain skills and independence^[2][3].

With or without thrombectomy, you will have care to help you get better, and you will receive medicine to prevent future blood clots^[6]. Follow-up care is a key part of your treatment and safety^[6]. Be sure to make and go to all appointments, and call your doctor if you are having problems^[6].