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Similarities and Differences Between Primary Percutaneous Coronary Intervention and Mechanical Thrombectomy
Estêvão Carvalho de Campos Martins1, Fernando Luiz de Melo Bernardi2, Orlando Teixeira Maia Junior3
1Hospital da Força Aérea do Galeão, Interventional Cardiology Unit, Rio de Janeiro, Brazil.
Insights
Mechanical thrombectomy (MT) is the gold standard for acute ischemic stroke. Interventional cardiologists can help expand access to this crucial treatment, but require specific training for the technical differences from percutaneous coronary intervention.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Medicine
Background:
- Acute ischemic stroke is a major global health concern, causing significant mortality and disability.
- Mechanical thrombectomy (MT) has emerged as the gold-standard treatment for large-vessel occlusion ischemic stroke since 2015.
- Limited availability of 24/7 neurointerventionalists restricts timely MT access worldwide.
Purpose of the Study:
- To provide a comprehensive guide for interventional cardiologists transitioning to mechanical thrombectomy.
- To highlight critical technical aspects and differences between MT and percutaneous coronary intervention.
- To address the growing demand for MT and its potential to alleviate the burden of acute ischemic stroke.
Main Methods:
- This state-of-the-art paper synthesizes current knowledge on mechanical thrombectomy.
- It focuses on the technical aspects relevant to interventional cardiologists.
- The review emphasizes clinical, technical, and environmental distinctions from percutaneous coronary intervention.
Main Results:
- Mechanical thrombectomy offers a vital treatment option for acute ischemic stroke.
- Interventional cardiologists possess transferable skills but require specialized training for MT.
- Understanding the nuances of MT is crucial for successful implementation and expanded patient access.
Conclusions:
- Interventional cardiologists are well-positioned to augment the workforce for mechanical thrombectomy.
- Bridging the gap in neurointerventionalist coverage can improve outcomes for stroke patients.
- Targeted education is essential to equip interventional cardiologists for the demands of mechanical thrombectomy.
Abstract:
Acute ischemic stroke is among the leading causes of mortality and disability worldwide. Since 2015, as was the case for primary percutaneous coronary intervention for acute myocardial infarction, catheter-based reperfusion via mechanical thrombectomy (MT) has become the gold-standard treatment for acute ischemic stroke caused by large-vessel occlusion. Despite that, only a fraction of the world's population currently would be able to undergo MT in time, mostly because of the scarcity of 24/7 coverage by neurointerventionalists to deal with this enormous burden. Interventional cardiologists have thus been considered a logical option to aid in combating this vast demand to diminish the burden of acute ischemic stroke. However, despite some seemingly evident similarities between primary percutaneous coronary intervention and MT, for interventional cardiologists to enter this new field, they must be well trained and fully aware of all the clinical, technical, and environmental differences between these two scenarios. The main objective of this state-of-the-art paper is to serve as an introductory and comprehensive guide to familiarize the interventional cardiology community with the most critical technical aspects of MT.
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