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Clinical Cohort

Mechanical Thrombectomy

Mechanical Thrombectomy

Mechanical thrombectomy, also called endovascular thrombectomy, is a procedure used to remove a blood clot from a large artery in the brain. It is an important treatment for eligible patients experiencing an acute ischemic stroke caused by a large-vessel blockage.

During the procedure, a specially trained physician guides a thin tube, called a catheter, through an artery to the blocked blood vessel in the brain. A stent retriever, suction device, or both may then be used to capture and remove the clot and restore blood flow.

Time Is Critical

Patients with a possible large-vessel occlusion should be identified and transferred for thrombectomy evaluation as quickly as possible.

Mechanical thrombectomy is most effective when blood flow is restored early. However, selected patients may still benefit from treatment as long as 24 hours after they were last known to be well, depending on brain imaging, the location of the blockage, stroke severity, and other clinical factors. Current guidance has expanded thrombectomy eligibility for some patients who may not have qualified under earlier recommendations.

Patients Who May Be Considered

Mechanical thrombectomy may be considered when:

  • The stroke is caused by a blockage in a large or medium brain artery.
  • The patient has a neurological deficit that may cause meaningful disability.
  • Brain and blood-vessel imaging identifies a clot that may be reached by catheter-based treatment.
  • Imaging suggests there is brain tissue that may still benefit from restored blood flow.
  • The expected benefit of treatment outweighs the risks.
  • The patient can be treated within an appropriate time window.

Treatment decisions should be made by a stroke and neurointerventional team using current national guidance and the facility’s approved stroke protocols.

Rapid Imaging and Evaluation

Evaluation commonly includes:

  • A noncontrast CT scan to check for bleeding
  • CT angiography or MR angiography to locate the blocked artery
  • Additional perfusion or advanced imaging when needed
  • A focused neurological examination
  • Review of the last-known-well time
  • Review of the patient’s medical history, medications, baseline abilities and treatment goals

Advanced imaging may help identify patients who could benefit from thrombectomy during a later or unknown treatment window.

TNK Should Not Delay Thrombectomy

Eligible patients may receive intravenous thrombolytic treatment, such as tenecteplase, while also being evaluated for mechanical thrombectomy.

TNK should not delay:

  • Blood-vessel imaging
  • Contact with a thrombectomy-capable center
  • Neurointerventional consultation
  • Hospital transfer
  • Preparation for the procedure

Thrombolytic medication and mechanical thrombectomy are complementary treatments. Giving TNK does not remove the need for thrombectomy when a treatable large-vessel blockage is present.

Transfer and Communication Best Practices

Hospitals that do not perform thrombectomy should have a clear transfer process for patients who may be eligible.

Strong stroke systems include:

  • Early activation of the stroke team
  • Rapid CT and blood-vessel imaging
  • Prompt contact with the receiving thrombectomy center
  • Immediate image sharing
  • A single-call transfer process when possible
  • Clear documentation of last-known-well and treatment times
  • Direct communication between the sending and receiving clinicians
  • Continued blood-pressure and neurological monitoring during transfer
  • Coordination with emergency medical services or air transport

Whenever possible, transfer arrangements should begin while the initial evaluation and treatment are still underway.

After the Procedure

Following thrombectomy, patients need close neurological and medical monitoring in a specialized stroke or intensive-care setting.

Care may include:

  • Frequent neurological examinations
  • Blood-pressure monitoring and management
  • Monitoring for bleeding or swelling in the brain
  • Care of the catheter access site
  • Repeat brain imaging when indicated
  • Swallowing screening
  • Prevention of complications
  • Early rehabilitation evaluation
  • Investigation of the cause of the stroke
  • Planning to reduce the risk of another stroke

Potential Risks

Mechanical thrombectomy can greatly improve outcomes for eligible patients, but it also carries risks. These may include:

  • Bleeding in or around the brain
  • Damage to a blood vessel
  • Movement of clot material into another artery
  • Bleeding or injury at the catheter entry site
  • Reaction to contrast material
  • Failure to fully reopen the blocked artery
  • Complications related to sedation or anesthesia

The treating team should discuss the expected benefits and risks with the patient or authorized decision-maker whenever the urgency of the situation allows.

Stay Current

Thrombectomy recommendations continue to change as new research becomes available. The 2026 American Heart Association/American Stroke Association guideline broadened eligibility for endovascular thrombectomy, including selected patients with larger areas of early brain injury and certain blockages in the back of the brain.

This information is intended for trained health-care professionals and is provided for education only. It does not replace clinical judgment, specialist consultation, current national guidelines, or an institutionally approved stroke protocol.

Nebraska Hosptials Offerring Mechanical Thrombectomies:

UNMC

Stroke Transfer Line:

Bergan 

Stroke Transfer Line:

Bryan Health

Stroke Transfer Line:

 

 

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