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1. Catheter Insertion and Vascular Access
The femoral artery (or occasionally the brachial or radial artery) provides access. Fluoroscopic guidance is used to progress a guiding catheter through the arterial system.
Intra-arterial Thrombolysis
Intra-arterial Thrombolysis
procedure steps
2. Getting to the Thrombus
A microcatheter is placed right at or very close to the thrombus in the blocked artery after being carefully inserted into the cerebral circulation through the major arteries.
3. Angiographic Verification
Injection of contrast dye verifies the microcatheter's location and gives a clear picture of the vessel's structure and the size of the clot.
4. Delivery of Thrombolytic Agents
To locally break the clot, a concentrated bolus or gradual continuous infusion of a thrombolytic drug (such as urokinase or alteplase) is injected directly into the thrombus via a microcatheter.
5. Observation and Modification
Angiograms are performed on a regular basis to evaluate clot lysis. The microcatheter may be moved to maximize delivery based on the patient's progress, or multiple boluses may be given if necessary.
6. Management of Duration and Dosage
In order to maximize effectiveness and reduce bleeding risk, the infusion usually lasts several hours (often longer than 12–24 hours), with careful dose and infusion rate adjustments.
7. Supplementary Measures
Adjunctive methods such as balloon angioplasty, stenting, or low-dose heparin infusion may be used if needed to maximize vascular patency.
8. Removal of the Catheter and Aftercare
All catheters are removed once recanalization is adequate. The patient's neurological condition and any potential problems, including bleeding or distal embolization, are continuously monitored.
disease treated
Ischemic Stroke
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Carotid Artery Stenosis
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suitable for
Individuals with Large Vessel Occlusion
Related Acute Ischemic Stroke: especially in the proximal middle cerebral artery, distal carotid, or basilar artery when IV thrombolysis is not recommended or is ineffective.
Beyond Standard IV Thrombolysis Time Window
Patients who present outside of the 4.5-hour window for IV tPA but within 6 hours of the beginning of symptoms, or up to 24 hours in certain circumstances based on imaging, are considered to be beyond the standard IV thrombolysis time window.
Patients with Contraindications to IV Thrombolysis
Individuals who are contraindicated for IV thrombolysis include those who have coagulopathy or an increased INR, which increases the danger of systemic thrombolytics.
When a Mechanical Thrombectomy Is Not Enough
In order to manage distant emboli, improve recanalization, or get past chronic blockage, IAT may be employed in addition to thrombectomy.
Patients with a favorable imaging profile
They showed little core infarct and a salvageable penumbra on MRI or perfusion imaging.
Younger Patients and Those with Moderate Stroke Severity
Patients under 68 years old, those with NIHSS scores between 11 and 20, and those with lower infarct volumes had better outcomes.
benefits
Increased Recanalization Rates
Compared to systemic IV thrombolysis alone, IAT can improve the reopening of blocked big arteries by delivering thrombolytic drugs directly to the clot.
Improved Functional Results
IAT in conjunction with mechanical thrombectomy has been linked to increased rates of functional independence at 90 days in a subset of patients with major artery occlusions.
Salvage of Distal Microcirculation
IAT may improve microvascular perfusion and lessen the no-reflow problem by dissolving microthrombi that mechanical devices cannot reach.
Rescue Therapy When IV Thrombolysis or Thrombectomy Is Inadequate
Helpful when thrombectomy is insufficient if systemic lytics are unable to completely destroy the clot.
Treatment Options After IV Thrombolysis Window
Under the guidance of sophisticated imaging, IAT can be used after the typical 4.5-hour limit for systemic thrombolysis.
Potentially Lower Mortality
When IAT is combined with mechanical thrombectomy, some research indicates a lower 90-day mortality rate without an increase in symptomatic cerebral bleeding.
post-treatment recovery
Quick Monitoring
In an intensive care or stroke unit, patients are continuously monitored for changes in their neurological condition, vital signs, and any bleeding consequences, particularly cerebral hemorrhage.
Imaging Monitoring
Within 24 hours after the treatment, routine brain imaging is carried out to verify vessel recanalization, check for bleeding, and measure brain tissue recovery.
Neurological Healing
Better long-term functional outcomes at three months are predicted by the fact that a sizable percentage of patients demonstrate fast neurological improvement within 24 hours.
Medicines
In order to prevent re-occlusion, antiplatelets or anticoagulants are often started 24 hours after hemorrhage is ruled out.
Aggressive management is used for blood pressure and other stroke risk factors.
Rehabilitation
In order to maximize recovery potential, early customized therapy for motor function, speech, cognition, and activities of daily living starts as soon as the patient is stable.
Modification of Risk Factors
Long-term care must include both medical and lifestyle management of high blood pressure, diabetes, cholesterol, quitting smoking, and other vascular risk factors.
Follow-up
