AcuteCare Telemedicine Blog


Major Advance in Chronic Stroke Treatment

For those who dedicate their professional careers to providing medical care to patients suffering from persistent and chronic disease, treatments that reduce disability and save lives do not come along often enough. And when they do come along, promising new technology and treatments all too often do not deliver on their initial promises after being subjected to critical clinical trials. But stroke experts are reporting a major advance in the treatment of chronic stroke which, after numerous clinic studies and trials, appears to be living up to the initial promises.

Stents similar to the ones used to open clogged heart arteries can now be used to clear a blood clot in the brain, greatly lowering the risk a patient will end up disabled. Most of the 800,000 strokes in the U.S. each year are caused by a blood clot lodged in the brain. Now an Endovascular device, a metal mesh cage called stent, can be inserted thorough a blocked blood vessel to more quickly retrieve and remove a clog. At a recent American Heart Association (AHA) International Stroke Conference in Nashville, TN doctors reported that patients treated with these brain stents were far more likely to be alive and able to live independently three months after their stroke. The treatment was so successful that three studies testing it were stopped early, so it could be offered to more patients. One study also found the death rate was cut almost in half for those given the treatment.

“This is a once-in-a-generation advance in stroke care,” said the head of one study, Dr. Jeffrey Saver, stroke chief at the University of California, Los Angeles. Early endovascular clot removal is improving stroke outcomes beyond those patients who received treatment with thrombolytics alone. “This is a real breakthrough,” agreed Patrick Lyden, MD, director of the stroke program at Cedars-Sinai in Los Angeles, “There’ve been very few people as critical as me about this procedure, but even I have to take a look at the data and say we have to believe this.”

The results shown from the three trials is a major verification of the treatments previously promised benefits. An independent expert, Dr. Lee Schwamm of Massachusetts General Hospital, called it “a real turning point in the field.” For those many patients who can be offered this treatment, “This is the difference between returning home and not returning home.”

The procedure could be offered to patients regardless of whether they’re a candidate for clot-dissolving medicine called tissue plasminogen activator (tPA), but the evidence supports the patient getting both treatments if eligible. Stroke care “needs to be completely changed” to make the treatment more widely available, said Dr. Walter Koroshetz, acting director of the National Institute of Neurological Disorders and Stroke. “This has taken stroke therapy to the same place that heart attack therapy is now,” he said.

Stent treatment of stroke has a narrow time window for use and is less effective for those who seek help too late. The key to surviving a stroke is recognizing the warning signs including; numbness or weakness on one side, confusion or trouble speaking, visual changes, and trouble walking, and then getting help within three to four hours after the onset of any of these symptoms.


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