On average, one American dies from a stroke every four minutes. Stroke is also the leading cause of adult disability in the United States and is the fifth leading cause of death among Americans. When a stroke occurs, rapid medical attention is crucial. When treatment is received promptly, a person has a far greater chance of surviving the stroke and more likely to have less lasting damage.
For many patients, that treatment is tissue plasminogen activator, or tPA. tPA is the only FDA approved treatment for ischemic strokes and works by dissolving the clot and improving blood flow to the brain. If administered within three hours (and up to 4.5 hours in certain eligible patients), tPA may improve the chances of recovering from a stroke. However, a significant number of stroke victims do not improve even with tPA, or cannot get tPA because they arrive at the hospital too late. Sometimes, the clot is too large for tPA to dissolve on its own.
A team of Northwestern Medicine stroke neurologists analyzed recent developments in acute stroke treatment for patients in whom tPA is not enough to open the blocked artery. In the April 14 issue of The Journal of the American Medical Association, the Northwestern Medicine stroke researchers reviewed new studies that show improved outcomes for these most severe stroke patients when clots are mechanically removed from arteries using a catheter to perform a procedure called thrombectomy.
Thrombectomy has been performed for many years in emergency situations when tPA could not be administered, but there was uncertainty about whether or not the procedure was effective. The landscape has changed dramatically in the last few months, with six large randomized trials showing that thrombectomy, with or without tPA, dramatically improves outcomes in patients with large clots in brain arteries. The JAMA article written by the Northwestern group encourages medical centers to adopt this therapy or build alliances with hospitals that can perform this procedure, so that it becomes the new standard of care for stroke patients. JAMA is one of the most widely read journals in medicine, and the review is expected to contribute to a major shift in practice.
This is good news for the most critical stroke patients, said Dr. Richard Bernstein, director of the stroke program and telestroke at Northwestern Memorial Hospital. Bernstein, along with Northwestern stroke neurologists Dr. Shyam Prabhakaran, faculty member at the Institute for Public Health and Medicine – Center for Healthcare Studies and Dr. Ilana Ruff, authored the study.
“We now can confidently treat acute stroke patients with a procedure that dramatically improved outcomes compared to intravenous tPA alone,” said Dr. Bernstein, who is also a professor of neurology at the Feinberg School of Medicine. “However, it’s important for patients to know that this is a complex procedure requiring a high level of technical expertise. It can only be done at a top tertiary care center like Northwestern Memorial Hospital.”
Northwestern Medicine has used thrombectomy for years and has a large team that specializes in this procedure. Prior to the recent research, it was performed only when established, standard of care therapies could not be used. However, now they expect to offer this treatment to a wider population of patients as a routine therapy, based on the new research.
“These findings represent a major shift in stroke treatment,” said Dr. Prabhakaran. “Compared to intravenous clot-busting drugs like tPA, mechanical removal of the clot results in up to 70 percent of patients living independent lives after major stroke, which is double the percentage seen with tPA alone. This means less disability from stroke, less costs related to rehabilitation, home care services and loss of productivity.”
See journal article: http://jama.jamanetwork.com/article.aspx?articleid=2247149