Dr Jeremy Madigan
Consultant interventional neuroradiologist, St George’s University Hospitals NHS Foundation Trust
A thrombectomy can take less than 60 minutes to save a patient’s life.
After some thrombectomies the difference to the patient is immediately obvious.
Some regain speech or movement even before they are off the table. Sometimes, says Dr Jeremy Madigan, consultant interventional neuroradiologist, St George’s University Hospitals NHS Foundation Trust, a patient’s ‘feedback’ from a thrombectomy is somewhat “memorable”, particularly if they have experienced discomfort. Doctors are rarely offended, he says, taking it as a welcome sign of promising neurological recovery.
How does a thrombectomy work?
In a thrombectomy the consultant makes a half centimetre nick in the groin area, from which a catheter (a thin, hollow tube) is thread into an artery and up to the brain where the clot is located. Once the catheter is in place, a tiny mechanical device – just a few millimetres in diameter – is used to remove the clot from inside the artery.
Latest generation devices, such as phenox’s pRESET and pRESET LITE stentrievers, feature a unique design, engineered for stability and incorporating a wire mesh trap, which self-expands into the clot. This opens up blood flow and grabs the clot at the same time for removal. The whole procedure usually takes under an hour and with no other invasive procedures required – that’s why sometimes the patient is often only partially sedated throughout.
The risk of thrombectomies
Of course, no medical procedure is without risk, which is why consultant neuroradiologists who carry out thrombectomies will have up to seven years specialist training in delivering the procedure. This is key to interpreting the pre-procedure diagnostic scans, choosing the most appropriate kit, such as the pRESET laser-cut stentriever, and having the technique to avoid complications such a potentially fatal bleed.
When all goes well – when the right information is available at the right time and there is the right equipment for that particular patient’s needs – the patient may go on to make a full recovery, needing only paracetamol for minor post-operative pain. Currently, though, St George’s is the only hospital in England to offer 24/7 thrombectomies, which isn’t good enough, says Dr Madigan. “How well a patient does is directly linked to how quickly and well we get their clot out.”