No…not these blockages….

 

New Stroke Guidelines Will Change Stroke Treatment in the U.S.

Each year, more than 690,000 Americans have strokes caused by blood clots blocking vessels in the brain, called ischemic strokes. Some of the clots can grow large and may require intense therapy to treat.

However, widely celebrated new research reaffirms that large blood clots in the brain are less likely to result in disability or death, if the blockage is removed in the crucial early hours of having a stroke.

Right now the standard treatment is a clot-dissolving drug called tPA. But it must be given intravenously within 4.5 hours to be effective. For people with larger brain clots, tPA only works about a third of the time.

New studies recommend doctors to use modernized -retrievable stents, to open and trap the clot, allowing doctors to extract the clot and reopen the artery nearly every time when used with tPA.

Clot-removing devices provide better outcomes for stroke survivors

0213-News-Removing clots_BlogStrokes caused by large blood clots in the brain are less likely to result in disability or death if the blockage is removed in the crucial early hours, according to reaffirming new research widely celebrated Wednesday.

Doctors quickly lauded the findings as instantly changing the way certain stroke sufferers are treated. The reason is because the results are not new, but validating: Dutch researchers in October had reached the same conclusion for the first time in a trial known as MR CLEAN.

Three new studies reported at the American Stroke Association’s International Stroke Conference reinforced those results from the Netherlands. The trials had been halted early because their results were so positive. Clot-grabbing devices used alongside a standard drug that dissolves clots, researchers said, can greatly improve the outcomes for people having the worst and most disabling strokes.

“This is a watershed moment in the management of acute stroke,” said Lee Schwamm, M.D., an American Heart Association volunteer and director of acute stroke services at Massachusetts General Hospital who was not involved in the studies. “Stroke is now a treatable disease in its earliest hours, and we can offer hope and promise to patients that early treatment can lead to dramatic reductions in disability and death.”

Each year, more than 690,000 Americans have strokes caused by blood clots blocking vessels in the brain, called ischemic stroke. The standard treatment is a clot-dissolving drug called tPA. But it must be given intravenously within 4.5 hours to be effective. For people with large clots it only works about a third of the time.

Doctors can see an image to detect the blockage

Solitaire_credit Covidien

 

 

 

 

 

 

 

Less sophisticated devices tested previously produced disappointing results in clinical trials. But the new studies tested more modern devices such as a retrievable stent, a tiny wire cage attached to a catheter that is threaded through an artery in the groin to the blocked artery in the brain. The stent opens and traps the clot, allowing doctors to extract the clot and reopen the artery nearly every time.

Among the new research is a Canadian study known as ESCAPE that involved 315 stroke patients. Most were given the clot-busting medicine tPA, and about half of them were also treated with a clot removal device.

Three months after their strokes, 53 percent of patients whose treatment included clot removal were functionally independent and able to take care of themselves compared with about 29 percent given tPA alone. The treatment also improved the odds of survival. In the clot-removal group, about 90 percent of patients were still alive after three months compared with 81 percent in the tPA-alone group. The results were published simultaneously in the New England Journal of Medicine.

Results were similar in a smaller Australian study called EXTEND-IA, also published simultaneously in the New England Journal of Medicine: 71 percent of stroke patients given both treatments were functionally independent after three months compared with 40 percent of those given tPA alone.

Bruce Campbell, M.D., a neurologist at the Royal Melbourne Hospital, led the Australian study and said clinical guidelines will now change.

“It’s a difference for patients between having paralysis down one side and not being able to talk compared to getting home and back to all their usual activities,” Campbell said.

Another study, dubbed SWIFT PRIME, involved 196 stroke patients in the United States and Europe. Researchers found that 60 percent given both treatments achieved functional independence three months later compared with about 36 percent given tPA alone. There were also fewer deaths among patients who had their clots removed: 9.2 percent versus 12.4 percent.

The next step will be to make sure stroke patients are taken to hospitals where specialists are on-hand to perform the clot-removing procedure, said Jeffrey Saver, M.D., a director at the UCLA Stroke Center and lead investigator of the SWIFT PRIME study. “We need to change the medical system,” he said.

Saver added that about 60,000 American stroke patients each year may be eligible for the new therapy.

In all three studies, the clot was removed from the blocked artery within six to 12 hours after stroke symptoms started. Researchers used simple imaging to quickly assess whether a stroke patient had a large clot.

Do you think you are having a stroke?

fast-stroke_499x204When diagnosing a stroke, time is critical. A quick diagnosis will ensure the use of treatment that can help with better results for your recovery.

Arrival at the Hospital

Provide detailed medical history and information about any past medical conditions. Knowing the exact time stroke symptoms began would be very helpful.

Initial Tests

Rule out any other conditions that have symptoms similar to a stroke.

Determine Type of Stroke

CT scan/MRI of the brain.

4 Begin Treatment

Ischemic Stroke (caused by blood clot)

Drug Treatment: clot-busting medications
Surgery: thrombectomy
Preventive Treatment: anti-coagulants, blood pressure-lowering or cholesterol lowering

Hemorrhagic Stroke (caused by bleeding)

Drug Treatment: to reduce bleeding and lower pressure
Surgery: craniotomy
Other: look for underlying cause of the stroke

Other Assessments

EKG; blood tests, including complete blood count, blood sugar, blood clotting time, electrolytes, liver and kidney function; MRI to find out the amount of damage to the brain; carotid ultrasound if narrowing of a carotid artery is suspected; MRA (magnetic resonance angiogram).

Fact or Myth……

 


MYTH


FACT

MYTH: Stroke cannot be prevented. FACT: Up to 80 percent of strokes are preventable.
MYTH: There is no treatment for stroke. FACT: At any sign of stroke call 9-1-1- immediately. Treatment may be available.
MYTH: Stroke only affects the elderly. FACT: Stroke can happen to anyone at any time.
MYTH: Stroke happens in the heart. FACT: Stroke is a “brain attack”.
MYTH: Stroke recovery only happens for the first few months after a stroke. FACT: Stroke recovery is a lifelong process.
MYTH: Strokes are rare. FACT: There are nearly 7 million stroke survivors in the U.S. Stroke is the 4th leading cause of death in the U.S.
MYTH: Strokes are not hereditary. FACT: Family history of stroke increases your chance for stroke.
MYTH: If stroke symptoms go away, you don’t have to see a doctor. FACT: Temporary stroke symptoms are called transient ischemic attacks (TIA). They are warning signs prior to actual stroke and need to be taken seriously.

Source: National Stroke Association