Thrombectomy

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A thrombectomy , also known as thromboembolectomy , is the surgical removal of a blood clot ( thrombus ) from a blood vessel . It is a relatively gentle method of reopening blood vessels that appear closed over long sections in the X-ray representation of the vessels ( angiography ). This can e.g. B. Occur in occlusions of the femoral arteries by an embolism in a mostly very short, high-grade constriction ( stenosis ); The blood in the pre-stenotic as well as post-stenotic vascular section may have clotted secondarily due to the reduced blood flow. However, embolisms often remain on the vascular branches, e.g. B. hang the inguinal artery or popliteal artery and then cause o. G. Phenomenon.

Procedure

For thrombectomy, a catheter (usually a so-called Fogarty catheter ) with a terminal, unfilled balloon is inserted into a thrombosed vessel that has previously been exposed and opened by means of a cross or longitudinal incision. Once the thrombus has passed, the balloon is filled with NaCl and withdrawn. This process is repeated until no more clots can be conveyed. In this way, the thrombus can be removed from the vessels in most cases.

This treatment is used in vascular surgery , neuroradiology and cardiology , especially in the treatment of embolized and secondary thrombosed peripheral arteries (see above). If the cause of the embolism is not treated , a new occlusion of the vessel can occur.

The advantages of neurothrombectomy in stroke therapy are so convincing that the treatment option should be available across the board in stroke units 24 hours a day. As a rule, a guide catheter is brought through the inguinal artery into the vessel supplying the brain ( internal carotid artery or vertebral artery ). A so-called stent retriever is then released into the blood clot via a microcatheter. After a few minutes for the blood clot to attach to the stent, it is pulled back into the guiding catheter. As a rule, this technique is combined with a second large-lumen catheter, which is brought up to the blood clot under suction in order to prevent parts of the thrombus from being washed away. The additional use of a guide catheter with an integrated balloon, which enables a short-term closure of the supplying blood vessel, is also possible. Some centers also try to open the vessel primarily via a suction catheter without a stent retriever and only use an additional stent retriever if this procedure fails.

literature

  • Thomas Cissarek: Vascular Medicine: Therapy and Practice . ABW Wissenschaftsverlag, Berlin 2009, p. 300 ff. ( Online )
  • Malte Ludwig: Angiology in clinic and practice . Georg Thieme Verlag, Stuttgart 1998, p. 201 ff. ( Online )
  • Bernd Pötzsch, Katharina Madlener: Coagulation Consultation: Rational diagnosis and therapy of coagulation disorders . Georg Thieme Verlag, Stuttgart 2002 ( online )
  • Wolfgang Hach: VenenChirurgie: Guide for vascular surgeons, angiologists, dermatologists and phlebologists . Schattauer Verlag, Stuttgart 2007, pp. 202–213 ( online )

Web links

Footnotes

  1. ↑ spiegel.de January 26, 2018: How doctors can now help more stroke patients