Thrombectomy and Thrombolysis

September 3, 2024

This page was reviewed under our medical and editorial policy by Jonathan Kessler, M.D., associate clinical professor, division of interventional radiology, Department of Diagnostic Radiology, City of Hope^® Cancer Center Duarte

People diagnosed with cancer are at greater risk for developing blood clots than those without the disease, especially if they have cancers of the lungs, kidneys, pancreas, stomach, colon, rectum or bone marrow (multiple myeloma).

Thrombectomy and thrombolysis are image-guided therapies that doctors called interventional radiologists may perform to treat blood clots. Interventional radiologists use X-rays, computed tomography (CT) scans, ultrasounds or other imaging techniques to see inside the body while they guide a device or tool to the area that needs treatment.

Patients may be particularly susceptible to developing blood clots if they are taking or undergoing certain cancer treatments. These may include:

• Major surgery
• Chemotherapy
• Hormone therapy drugs like Nolvadex® (tamoxifen)
• Certain targeted drug therapies or immunotherapy treatments
• Certain treatments that stimulate red blood cell production

What Is a Thrombectomy?

Thrombectomy is a procedure to remove a blood clot or clots using a mechanical device. The device is inserted into the patient’s blood vessels by an interventional radiologist. The radiologist uses image guidance, which shows pictures on a screen for the doctor to view inside the body.

Different mechanical devices may be used to physically remove the blood clot, including aspiration catheters (flexible tubes through which the clot is suctioned out), stent retrievers (small tools that trap the clot), suction tools, guidewires and pumps.

The doctor may recommend a thrombectomy for certain types of clots, especially those that develop large veins and the lungs. A blood clot in the lungs is called a pulmonary embolism.

Thrombectomy Procedure

Before a thrombectomy procedure, the patient is given sedation to relax and local anesthesia to numb the area where the catheter is inserted.

During the thrombectomy, the interventional radiologist places a catheter into a vein, typically in the upper thigh or above the collarbone. Live X-ray pictures are typically used to help the physician guide the catheter to the place where the clot is blocking blood flow.

The physician may then perform a procedure called angioplasty to expand the blood vessel by blowing up a balloon that is attached to the catheter. A variety of other tools may then be used to help remove the blood clots.

Thrombectomy Versus Embolectomy

When a clot remains in the blood vessel where it formed, it is known as a thrombus. If part or all of it breaks away and travels elsewhere to wedge or stick in another blood vessel, it is known as an embolus.

Thrombectomy is used to treat a thrombus, while embolectomy is used to treat an embolus. In both cases, the clot or clots that are restricting the flow of blood (and the oxygen it carries) are removed. This helps reduce or stop tissue damage or tissue death from occurring due to lack of oxygen to the cells.

Thrombectomy Recovery

Patients are likely to stay in the hospital for a few days or longer to allow the health staff to watch for complications.

To help prevent formation of additional blood clots, medicine may be given during the recovery period, and the doctor may also recommend wearing compression stockings.

After being released from the hospital, patients undergo follow-up imaging of their blood vessels, which allows the doctor to check for new blood clot formation.

What Is Thrombolysis?

Thrombolysis is a procedure that uses medication to break up a clot. The medication that is typically used is called tissue plasminogen activator (TPA).

TPA is a substance made naturally by the body to help break up clots, and synthetic versions are produced in the laboratory. It is injected into the clot during the procedure.

Thrombolysis may be used to treat clots that develop in the lungs, brain, in or near the heart, or deep in the veins of the leg or lower pelvis (deep vein thrombosis). The procedure is also used for clots that develop in any number of peripheral blood vessels (vessels located outside the heart), particularly for emergency blockages.

Thrombolysis Procedure

During thrombolysis, medication is either delivered through an intravenous (IV) line that is inserted into a vein or through a catheter that is inserted using X-ray guidance until it reaches the site of the blood clot (catheter-directed thrombolysis).

The length of the treatment varies, based on the condition being treated. For example, it may take about an hour to treat a blood clot in the heart and a few days to treat deep vein thrombosis using thrombolysis.

Is Thrombolysis a Major Surgery?

Thrombolysis is not considered major surgery. It is a minimally invasive technique that may reduce the risks of bleeding or other complications that come with major surgery. This is because minimally invasive surgery uses a small cut or cuts and just a few stitches. The technique may lead to faster recovery times for patients than major surgery.

Thrombolysis Recovery

The doctor monitors the patient for complications after thrombolysis, such as an embolus, bleeding, low blood pressure (hypotension), allergic reactions and irregular heartbeat (arrhythmia). Imaging tests will be used to see if the treatment cleared away the clot. If the blood clot is not completely dissolved, additional procedures, such as angioplasty, stenting, thrombectomy or open surgery, may be recommended.

If the blood clot is dissolved, the patient is given blood thinner medication to reduce the risk of a future blood clot. Sometimes additional procedures to help keep the blood vessel open (like angioplasty) are recommended even when a thrombolysis procedure is successful if the doctor determines the patient is at risk of developing another clot in the area.

The interventional radiologists at City of Hope^Ⓡ combine collaboration with cancer doctors, surgeons and medical oncologists and advanced diagnostic imaging techniques to provide patients undergoing thrombectomy and thrombolysis world-class treatment, care and support during their journey to recovery.