Claim: Heart Association's Stroke Guidelines Support Clot-Removing Device If clot-busting drugs don't work, device can be used to pull the blockage out through the artery
Verdict: SUPPORTS

Retrieved passages:
title: Stroke
text: possibly aspirin, statins, surgery to open up the arteries to the brain in those with problematic narrowing, and warfarin in those with atrial fibrillation. A stroke or TIA often requires emergency care. An ischemic stroke, if detected within three to four and half hours, may be treatable with a medication that can break down the clot. Aspirin should be used. Some hemorrhagic strokes benefit from surgery. Treatment to try to recover lost function is called stroke rehabilitation and ideally takes place in a stroke unit; however, these are not available in much of the world. In 2013 approximately 6.9 million

title: Stroke
text: angioplasty can be used to remove atherosclerotic narrowing of the carotid artery. There is evidence supporting this procedure in selected cases. Endarterectomy for a significant stenosis has been shown to be useful in preventing further strokes in those who have already had one. Carotid artery stenting has not been shown to be equally useful. People are selected for surgery based on age, gender, degree of stenosis, time since symptoms and the person's preferences. Surgery is most efficient when not delayed too long —the risk of recurrent stroke in a patient who has a 50% or greater stenosis is up to

title: Atherosclerosis
text: like aspirin help to prevent clots, and a variety of antihypertensive medications are routinely used to control blood pressure. If the combined efforts of risk factor modification and medication therapy are not sufficient to control symptoms, or fight imminent threats of ischemic events, a physician may resort to interventional or surgical procedures to correct the obstruction. Treatment of established disease may include medications to lower cholesterol such as statins, blood pressure medication, or medications that decrease clotting, such as aspirin. A number of procedures may also be carried out such as percutaneous coronary intervention, coronary artery bypass graft, or carotid

title: Cerebral infarction
text: plasminogen activator (tPA), is used to dissolve the clot and unblock the artery. Another intervention for acute cerebral ischaemia is removal of the offending thrombus directly. This is accomplished by inserting a catheter into the femoral artery, directing it into the cerebral circulation, and deploying a corkscrew-like device to ensnare the clot, which is then withdrawn from the body. Mechanical embolectomy devices have been demonstrated effective at restoring blood flow in patients who were unable to receive thrombolytic drugs or for whom the drugs were ineffective, though no differences have been found between newer and older versions of the devices.

title: Human brain
text: look for clots within the heart, diseases of the heart valves or the presence of a patent foramen ovale. Blood tests are routinely done as part of the workup including diabetes tests and a lipid profile. Some treatments for stroke are time-critical. These include clot dissolution or surgical removal of a clot for ischaemic strokes, and decompression for haemorrhagic strokes. As stroke is time critical, hospitals and even pre-hospital care of stroke involves expedited investigations – usually a CT scan to investigate for a haemorrhagic stroke and a CT or MR angiogram to evaluate arteries that supply the brain. MRI

title: Left atrial appendage occlusion
text: or adherence issues. This applies particularly to the elderly, although studies have indicated that they can also benefit from anticoagulants. Left atrial appendage closure is an implant-based alternative to blood thinners. Like blood thinning medications, an LAAC implant does not cure AF. A stroke can be due to factors not related to a clot traveling to the brain from the left atrium. Other causes of stroke can include high blood pressure and narrowing of the blood vessels to the brain. An LAAC implant will not prevent these other causes of stroke. On March 13, 2015, the U.S. Food and Drug

title: Carotid artery stenosis
text: goal of treatment is to reduce the risk of stroke (cerebrovascular accident). Intervention (carotid endarterectomy or carotid stenting) can cause stroke; however, where the risk of stroke from medical management alone is high, intervention may be beneficial. Clinical guidelines (such as those of National Institute for Clinical Excellence (NICE)) recommend that all patients with carotid stenosis be given medication, usually blood pressure lowering medications, anti-clotting medications, anti-platelet medications (such as aspirin or clopidogrel), and especially statins (which were originally prescribed for their cholesterol-lowering effects but were also found to reduce inflammation and stabilize plaque). In selected trial participants with asymptomatic

title: Intermittent claudication
text: affected muscles and allow for increased activity levels. Angiotensin converting enzyme inhibitors, adrenergic agents such as alpha-1 blockers and beta-blockers and alpha-2 agonists, antiplatelet agents (aspirin and clopidogrel), naftidrofuryl, pentoxifylline, and cilostazol (selective PDE3 inhibitor) are used for the treatment of intermittent claudication. However, medications will not remove the blockages from the body. Instead, they simply improve blood flow to the affected area. Catheter-based intervention is also an option. Atherectomy, stenting, and angioplasty to remove or push aside the arterial blockages are the most common procedures for catheter-based intervention. These procedures can be performed by interventional radiologists, interventional cardiologists, vascular

title: Left atrial appendage occlusion
text: newer approved blood thinners) are very effective in lowering the risk of stroke in AF patients. Most patients can safely take these medications for years (and even decades) without serious side effects. However, some patients find that blood thinning medications can be difficult to tolerate or are risky. Because they prevent blood clots by thinning the blood, blood thinners can increase the risk of bleeding problems. In select patients, physicians determine that an alternative to blood thinners is needed to reduce AF stroke risk. Approximately 45% of patients who are eligible for warfarin are not being treated, due to tolerance

title: Myocardial infarction
text: blood vessels of the heart. The probes are then used to identify and clear blockages using small balloons, which are dragged through the blocked segment, dragging away the clot, or the insertion of stents. Coronary artery bypass grafting is only considered when the affected area of heart muscle large, and PCI is unsuitable, for example with difficult cardiac anatomy. After PCI, people are generally placed on aspirin indefinitely and on dual antiplatelet therapy (generally aspirin and clopidogrel) for at least a year. If PCI cannot be performed within 90 to 120 minutes in STEMI then fibrinolysis, preferably within 30 minutes

title: Stroke
text: that objective evidence regarding the efficacy, safety, and applicability of tPA for acute ischemic stroke is insufficient to warrant its classification as standard of care. Intra-arterial fibrinolysis, where a catheter is passed up an artery into the brain and the medication is injected at the site of thrombosis, has been found to improve outcomes in people with acute ischemic stroke. Surgical removal of the blood clot causing the ischemic stroke may improve outcomes if done within 7 hours of the start of symptoms in those with an anterior circulation large artery clot. It however does not change the risk of

title: Paradoxical embolism
text: systemic arteries as a paradoxical embolism. Once in the arterial circulation, a clot can travel to the brain, block a vessel there, and cause a stroke (cerebrovascular accident). CT angiography. Therapeutic preventional anticoagulation is first line, if correction of the underlying anatomical pathology is not already done, by using Heparin or other anticoagulative agents. This approach is also used in the treatment of a present embolism, albeit at higher doses. Once these are exhausted or the use of therapeutic anticoagulation is contraindicated (for example, in a cooccurring traumatic hemorrhage), mechanical thrombectomy may be used to physically remove the embolism from

title: Stroke
text: early on. Definitive therapy within the first few hours is aimed at removing the blockage by breaking the clot down (thrombolysis), or by removing it mechanically (thrombectomy). The philosophical premise underlying the importance of rapid stroke intervention was summed up as "Time is Brain!" in the early 1990s. Years later, that same idea, that rapid cerebral blood flow restoration results in fewer brain cells dying, has been proved and quantified. Tight blood sugar control in the first few hours does not improve outcomes and may cause harm. High blood pressure is also not typically lowered as this has not been

title: Heart arrhythmia
text: slow conduction through the heart, without actually preventing an arrhythmia. These drugs can be used to "rate control" a fast rhythm and make it physically tolerable for the patient. Some arrhythmias promote blood clotting within the heart, and increase risk of embolus and stroke. Anticoagulant medications such as warfarin and heparins, and anti-platelet drugs such as aspirin can reduce the risk of clotting. Arrhythmias may also be treated electrically, by applying a shock across the heart — either externally to the chest wall, or internally to the heart via implanted electrodes. Cardioversion is either achieved pharmacologically or via the application

title: Carotid endarterectomy
text: in the artery. A piece of the formed blood clot often breaks off and travels (embolizes) up through the internal carotid artery into the brain, where it blocks circulation, and can cause death of the brain tissue, a condition referred to as ischemic stroke. Sometimes the stenosis causes temporary symptoms first, known as TIAs, where temporary ischemia occurs in the brain, spinal cord, or retina without causing an infarction. Symptomatic stenosis has a high risk of stroke within the next 2 days. National Institute for Health and Clinical Excellence (NICE) guidelines recommend that patients with moderate to severe (50–99% blockage)

title: Off-pump coronary artery bypass
text: may break loose during CABG procedure manipulation. This debris can result in clots, or “emboli”, that may interrupt the flow of blood to the brain, causing neurological damage or even stroke. Data analysis from beating heart surgery patients shows a significant reduction in the release of this debris with correspondingly lower stroke rates. The fatty emboli which cause brain damage are generated when the large artery from the heart (aorta) is manipulated and although these are reduced in most off-pump coronary bypass surgeries they are not eliminated because the aorta is still used as a site to attach some of

title: Transient ischemic attack
text: giving both aspirin and clopidogrel within 24 hours of a TIA or minor stroke is more effective than aspirin alone. Another antiplatelet, ticlopidine, is rarely used due to increased side effects. Anticoagulants may be started if the TIA is thought to be attributable to atrial fibrillation. Atrial fibrillation is an abnormal heart rhythm that may cause the formation of blood clots that can travel to the brain, resulting in TIAs or ischemic strokes. Atrial fibrillation increases stroke risk by five times, and is thought to cause 10-12% of all ischemic strokes in the US. Anticoagulant therapy can decrease the relative

title: Thrombectomy
text: Thrombectomy Mechanical thrombectomy, or simply thrombectomy, is the interventional procedure of removing a blood clot (thrombus) from a blood vessel. It is commonly performed in the coronary arteries (interventional cardiology), peripheral arteries (interventional radiology) and cerebral arteries (interventional neuroradiology). Ischemic stroke represents the second most common cause of death in western world. Until recent times, systemic intravenous fibrinolysis was the only evidence-based therapy for patient with acute onset of stroke due to large vessel occlusion. In 2015, the results of five trials from different countries were published in the New England Journal of Medicine, demonstrating the safety and efficacy of

title: Ischemia
text: inserted into the femoral artery and threaded to the site of the clot is used to infuse the drug. Unlike anticoagulants, thrombolytic agents work directly to resolve the clot over a period of 24 to 48 hours. Direct arteriotomy may be necessary to remove the clot. Surgical revascularization may be used in the setting of trauma (e.g., laceration of the artery). Amputation is reserved for cases where limb salvage is not possible. If the patient continues to have a risk of further embolization from some persistent source, such as chronic atrial fibrillation, treatment includes long-term oral anticoagulation to prevent further

title: Transient ischemic attack
text: for secondary prevention of stroke after most TIAs. An exception is TIAs due to blood clots originating from the heart, in which case anticoagulants are generally recommended. After TIA or minor stroke, aspirin therapy has been shown to reduce the short-term risk of recurrent stroke by 60-70%, and the long-term risk of stroke by 13%. The typical therapy may include aspirin alone, a combination of aspirin plus extended-release dipyridamole, or clopidogrel alone. Clopidogrel and aspirin have similar efficacies and side effect profiles. Clopidogrel is more expensive and has a slightly decreased risk of GI bleed. There is some evidence that