Validated by the French National Authority for Health in 2017, mechanical thrombectomy offers a new alternative to the management of cerebrovascular accident (stroke), which must be as early as possible. This technique consists of removing the clot that blocks the cerebral artery by endovascular route and using a stent, in order to restore blood circulation.

Thrombectomy, from the Greek thrombus for “clot”, and ktomy for “abalation” consists in removing, by the endovascular route, a blood clot obstructing a cephalic artery and causing an ischemic cerebrovascular accident (AVC), that is to say a cerebral infarction.

A recent and innovative technique, mechanical thrombectomy constitutes an alternative or a complement to the classic management of stroke in the acute phase, hitherto based on intravenous thrombolysis, or fibrinolysis, which consists of injecting a product aimed at disintegrating the blood clot. To be effective, thrombolysis must be performed as soon as possible, i.e. 4 hours 30 minutes after the appearance of the first signs of stroke.

Mechanical thrombectomy is performed in the hospital, in an approved interventional neuroradiology service, by an interventional neuroradiologist trained in this highly technical practice. At present, thrombectomy, a recent technique, is not performed in all establishments.

The intervention takes place under local anesthesia or under general anesthesia depending on the clinical condition of the patient.

Under radiological control, a large caliber catheter is introduced in the groin, into the femoral artery, and ascended to the brain, to the blocked cerebral artery. Different arteriographic images and an injection of iodinated contrast product are taken to determine the area and the degree of obstruction.

A microcatheter is then introduced into the large catheter. This microcatheter is equipped with a device for removing the clot. There are different types:

• Coil retrievers (first generation of mechanical thrombectomy device): the interventional neuroradiologist deploys the stent through the clot to engage the thrombus, then pulls both the stent and the clot through the catheter, like a puller. Cork ;
• the suction devices are connected to a pump and coupled with a separator which allows fragmentation of the clot to facilitate its extraction;
• Newer and best performing, stent retrievers are small wire mesh nets that capture the clot in their mesh.

Mechanical thrombectomy is recommended in the acute phase for the treatment of ischemic stroke up to 6 hours after the onset of symptoms in patients with proximal occlusion of the cerebral arteries (carotid, middle cerebral, basilar trunk).

Mechanical thrombectomy can be performed in addition to intravenous thrombolysis or immediately if the latter is contraindicated.

In its evaluation report, the HAS concludes that “Overall, the data from the literature analyzed suggest that mechanical thrombectomy in combination with IV fibrinolysis, when used in conjunction with non-invasive arterial imaging, in certain patients. patients having presented an acute ischemic stroke of the anterior circulation, and when using second generation devices (retriever stent), has a beneficial effect on morbidity and functional impact (autonomy and dependence), and the quality of life at 90 days, but no effect on all-cause mortality at 90 days.

Thus, mechanical thrombectomy would allow better recovery and reduce the risk of sequelae.