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“One of the best treatments discovered in the last 50 years” What is thrombectomy and its benefits?

“Some clinicians say it’s one of the best treatments discovered in the last 50 years in any field of medicine because it is that effective.”

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In season 1 of the SR Times Podcast we spoke with stroke expert Dr Sanjeev Nayak who explained the thrombectomy procedure, its benefits and the likelihood of returning home after thrombectomy.

A blocked drain

Dr Nayak simplifies the thrombectomy procedure by comparing it to a blocked sink, he says: “I’ll make it very simple. If you have a small kitchen sink, which is blocked, and you put a little bit of unblocker in, it does open up.

“Now, let’s say you have a large block in the street, which is blocking the supply to the house, putting a little bit of drain powder in, that won’t work. You need a plumber to physically to go in and open up the blockage. 

“So, that is what we need in the brain, if there is a large blockage of one of the large vessels, these drugs [thrombolysis] don’t work as effectively as they should, or they won’t work because he blockage is quite big.

“In this situation you have to physically go in and remove the blockage.”

The procedure 

With Dr Nayak’s analogy of blocked drains in mind, it is easy to picture how the procedure works as he explains it: “What we do is introduce a tube or catheter from the groin artery in the groin and set it all the way to the major artery in the neck, what we call a carotid artery.

“From there we take a smaller tube, or what we call the micro catheter across into the brain and place a device known as a stent, which is a mesh like device and we place that in the clot.

“Once the device is placed in the clot, it’s made of nitinol and it expands at body temperature and it engages with the clot. The clot gets attached to this particular stent device and we pull that device along with the clot out of the body through the same catheter.

“In a way we achieve what we call repercussion of the brain, the blood flows back into the brain where there was a previous blockage.”

The benefits 

Dr Nayak highlights the importance of timing when it comes to the treatment of stroke, he says: “If you have a large vessel stroke or make a major stroke, you can benefit from thrombectomy. For this treatment, the best option is [to be treated] within six hours.

“In select cases with specialised imaging, you can extend the treatment window up to 24 hours.”

In terms of comparing thrombectomy to traditional methods of stroke treatment, for Dr Nayak there is a clear difference: “It’s fast, most superior, because you can physically remove the clot from the occluded vessel, whereas the drug which is previously used [thrombolysis], would only act in 20% of the patients.

“So in this case, you’re more effective in removing the clot, and if you remove the clot, and if it’s within time, you can get what some of the clinicians call miraculous treatment, patients with a major stroke would recover sometimes on the table, we have seen them recovering on the operating table, or within 24 hours.

“Some clinicians say it’s one of the best treatments discovered in the last 50 years in any field of medicine because it is that effective.”

Returning home

Thrombectomy has a very successful rate of patients who go through this procedure returning home, rather than having to go to a care home, Dr Nayak refers to a cost analysis that was done alongside NICE, he says: “We have done a cost analysis with NICE and in our cost analysis we have shown, in terms of the stay in the hospital, we showed that  91 per cent or 92 per cent of our patients are discharged home rather than a nursing home.

“Previously, somebody with a large stroke, and with a bad outcome would have been discharged to a nursing home, because they will require a long term care. However, here we are showing 90+ per cent of the patients are discharged home.

“We also showed a significant percentage of our patients, because of thrombectomy were discharged within one week.”

The full episode with Dr Sanjeev Nayak is available on both Spotify and Apple Podcasts.

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