What about those patients who do not make it to the hospital within three hours of stroke symptom onset or those who are not candidates for t-PA?
In general, t-PA is not recommended for stroke patients who are beyond the three-hour window after the onset of symptoms. There are also multiple medical conditions, such as a recent stroke, history of excessive bleeding, severe hypertension, a known brain aneurysm, and many others which increase the risks associated with IV t-PA.
Help in fending off the debilitating side effects of stroke for these types of patients and those who simply do not respond to t-PA therapy arrived with the introduction of the Merci Retrieval System®. The Merci retriever is a coil that an interventionist threads through the artery with a catheter. Once it reaches the clot, it coils around the clot, trapping it so the interventionist can pull it out of the artery. Once the clot is dislodged and retrieved, blood flow returns to the brain.
Interventionists at WakeMed also use a different type of technology to remove clots and stop strokes in their tracks. The Penumbra System uses suction instead of a coil to pull the clot out of the artery. For some interventions, the Penumbra offers an advantage because you don’t have to feed a coil all the way up to the clot.
The clot retrieval devices are most appropriate for patients who have large vessel blockages that are confirmed by specialized CT imaging. Both technologies are effective; the one that’s used really depends on physician preference.