thrombectomy, a “revolutionary” technique
In France, a stroke, a stroke, occurs about every 4 minutes. For a little over 10 years, a new technique has appeared: intra brain mechanical thrombectomy. We explain how this specialty is revolutionary.
From Wednesday, 5 to Friday, February 7, Clermont-Ferrand welcomes the session of the National Thrombectomy School. This event brings together the greatest specialists in the thrombectomy in our country, to present and teach the latest advances in terms of stroke.
Thrombectomy is a gesture of cerebral arterial disobelt implemented in interventional neuroradiology services specialized in the management of strokes. A stroke is approximately occurred in France every 4 minutes: this represents just over 150,000 BC per year. Of this total, 20 to 30,000 patients could benefit from thrombectomy. Strokes are of two types: hemorrhagic accidents, when there is a bleeding in the brain, and ischemic stroke, which correspond to insufficient cerebral infusion, which can be linked to an obstruction of the arteries supplying the brain linked to stenosis (narrowing of the artery) atheromatous, or at the migration of embolity (a clot that clogs a blood vessel). Hemorrhagic accidents are the least frequent but the most complicated to take care of. Ischemic accidents represent most strokes. Heart rhythm disorders can be involved, as is atheromatous disease, that is to say arterial aging. Professor Louis Boyer, head of the Clermont-Ferrand CHU radiology, details how thrombectomy works: “This will consist in reopening an artery closed by stenosis or occlusion, and aspiring clots that are in the intracerebral vessels, in order to restore brain infusion”.
The clinical signs of the most obvious stroke are a speech disorder, a paralysis that can concern the face, the upper or lower limbs. Dr. Géraud Forestier, neuroradiologist hospital practitioner in radiology at the Clermont Ferrand University Hospital, insists: “If we observe these signs occurring suddenly, it is necessary to call on the 15th, who will be able to coordinate with emergency physicians and neurologists care: transport within the shortest possible time to allow a neurologist to assess the Clinical condition of the patient before carrying out brain imaging in radiology: scanner or MRI. What matters is not to waste time because the goal is to quickly determine the cause of these symptoms”.
Professor Louis Boyer recalls: “Thrombectomy is a technique that dates from the beginning of the 2010s. It was assessed and it has been considered that it was reliable, useful and necessary from 2015 in Europe”. This technique has been practiced at Clermont-Ferrand CHU since 2012-2013. This intervention, which benefits from the contribution of a team of resuscitatory anesthesiologists, consists of a mechanical revascularization, which can be obtained in less than 30 minutes. For more complex cases, the intervention can take two hours. Professor Louis Boyer indicates: “When we talk about duration, the main thing is linked to the delay between the installation of symptoms and the arrival in the vascular interventional neuroradiology room. If we implement the gesture later, even if it is technically successful, the brain recovers less well. Previously, there was almost no other therapeutic possibility, apart from thrombolysis, limited to certain indications: the use of drugs to dissolve clots is not possible in all cases. Thrombectomy is a revolution for the management of ischemic strokes”.
Dr. Géraud Forestier highlights the strengths of thrombectomy: “We manage to go distant in the arteries of the brain by being mini-invasive. To access it, we punctuate a superficial artery, with the fold of the groin: the femoral artery, and we will look for the clot which is a more meter Far, in the middle of the brain, by sailing in the arteries with pipes called catheters. There is no surgery itself. In terms of therapeutic effect, it is comparable to the advent of antibiotics: a revolution. In terms of efficiency, 40 % of treated patients derive a major profit from it, and instead of remaining severely disabled, with sequelae of heavy strokes, they can find a functional brain after care in physical medicine and rehabilitation”. This intervention is comparable to what is done for coronary arteries in the heart.
Thrombectomy is increasingly practiced and taught, with new tools. Today, 53 centers in France are practicing this intervention. Professor Louis Boyer concludes: “This disease does not prevent. It presupposes availability 24 hours a day. Statistically, there are more gestures made outside hours and working days. To make thrombectomies, it is therefore necessary to guarantee a permanence of the care that is complete and serious. This assumes that there is a sufficient number of operators”. At the National School of Thrombectomy organized in Clermont-Ferrand each year, around thirty radiologists are trained in this technique to strengthen the enrollment of competent interventional radiologists. This event is organized by the deer (College of Radiology Teachers of France), the SFR (French Radiology Society) and its specialized subsidiary SFNR (Neuro Radiology).
