Thrombectomy and Stroke Rehabilitation Summary

Overview of Thrombectomy

• Definition: Thrombectomy is a procedure aimed at removing plaque from blood vessels that can cause strokes.

• Indications for Use:

  • Mechanical thrombectomy is appropriate for patients displaying acute stroke symptoms.
  • Effective for blood clots within larger blood vessels (diameter of a few millimeters).

• Procedure:

  • Involves a catheter that enters through the femoral artery and navigates to the brain.
  • Various tools are used to capture and remove blood clots.
  • Recovery is generally swift with hole sealing in hours; severity of the stroke affects recovery timelines.

• Patient Monitoring: After the procedure, patients are followed for 2-4 weeks to ensure proper medication and rehabilitation.

Requirements for Thrombectomy

• Plaque must reside in larger vessels to qualify for this procedure.
• Stable plaque conditions are required for effective retriever function; small or unstable plaques may hinder effectiveness.

Procedure Guidance

• Fluoroscopy: Similar imaging techniques are used during thrombectomy and angioplasty to guide catheter positioning.

• Cerebral Bypass Surgery:

  • A surgical route to create alternative blood flow paths in the brain when blockages occur.
  • Utilizes vessels from the brain itself rather than from other body parts.
  • Can be extracranial-to-intracranial (donor vessel from skull to brain) or intracranial-to-intracranial (donor vessel from within the brain).

Pharmacological Treatments

• TPA (Tissue Plasminogen Activator):
  • Effective within the first three hours of stroke onset, helps dissolve clots.
  • Risk of hemorrhage, making careful assessment necessary before administration.
• Long-term medications include anticoagulants (e.g., Warfarin), antiplatelets (e.g., Clopidogrel), and ACE inhibitors to prevent future strokes.

Rehabilitation Post-Stroke

• Many survivors require rehabilitation services:

  • Physical Therapy: To regain motor functions lost due to stroke.
  • Occupational Therapy: Aids in relearning daily tasks.
  • Speech Therapy: Addresses communication skills.

• Psychosocial Support: Essential for mental health; many stroke survivors deal with depression and anxiety.

Exercise Testing and Prescription

• Testing Considerations: Stroke is not a contraindication for exercise testing, but effects on cognitive and physical abilities must be considered.
• Exercise Protocols:
  • Customize testing protocols to accommodate stroke effects.
  • Self-selecting speed and gradual intensity increases are preferred for safety.
• Functional Capacity Development:
  • Average VO2 max in stroke patients is 14.4 mL/kg/min, well below the independence threshold of around 20 mL/kg/min.
  • Focus on aerobic exercises and resistance training tailored to the affected side to improve strength and balance.

Addressing Spasticity and Flexibility

• Spasticity often presents in stroke patients, affecting flexibility and muscle control.
• Stretching and Strengthening:
  • Focus on restoring muscular balance particularly in areas like the wrist through targeted exercises.
• Basic Movements:
  • Easy exercises help restore function and are adjustable based on patient capability.
  • Incorporate activities that mimic daily living and increase patient's functional independence.

Conclusion

• Comprehensive stroke treatment encompasses surgical, pharmacological, and rehabilitative approaches, with tailored exercise prescriptions aimed at restoring overall health and function.