(photo credit: WWW.PIKIWIKI.ORG.IL)
Urgent catheterization to remove blood clots from the brains of patients who have undergone moderate-to-serious strokes can save lives and prevent serious disability, according to results of four studies presented recently at an international stroke conference in Nashville, Tennessee.
The new studies of the process known as thrombectomy “constitute the biggest breakthrough in the treatment of stroke in the last two decades and important news for victims of a serious stroke who are not candidates for or do not react to treatment to melt clots,” Prof. David Tena, director of the Center for Prevention and Treatment of Stroke at Sheba Medical Center and secretary of the Israel Neurology Society, said on Sunday.
The studies “showed clearly and for the first time that urgent use of a catheter to remove the clot causing acute stroke is dramatically effective” in saving lives and preventing major disability, said Tena, who attended the conference.
The removal of the clots, which prevent oxygen-rich blood from passing through the brain, was accomplished with new techniques including CT angiography to precisely locate the clot and determine whether enough healthy brain tissue remains to make the thrombectomy effective.
Standard treatment for strokes entails giving tPA (tissue plasminogen activator) to dissolve the clot, but this technique is not always possible, according to Tena, a specialist in neurology and vascular brain disease. “Fishing out the clot can significantly increase the number of stroke patients who can be saved from severe handicap and nursing care. Thanks to the thrombectomy, they can return to their work and lives.”
The catheter is usually introduced into the brain via an artery in the groin, while the patient is under anesthesia.
A stent-like device is used to “capture” the clot and pull it out via the opening of the artery in the groin.
The treatment is suitable to treat ischemic strokes caused by the blockage of blood vessels in the brain, the first signs of which are weakness or paralysis in a hand or leg, or difficulty speaking, seeing or understanding.
Without rapid treatment, brain damage is likely to be permanent, Tena said.
Still not every one of these patients is suitable for the treatment as they must have arrived very quickly after the stroke and the brain must not already be seriously damaged. Therefore, said the Sheba neurologist, “potential patients must be selected carefully.”
In Israel alone, some 9,000 men and women are hospitalized annually for ischemic stroke, 700 of whom are treated with an infusion of tPA. About a third of the 9,000 will suffer an acute blockage of a major brain artery, Tena said, noting that 1,000 or so would be candidates for thombectomy.
Both thrombectomy and tPA can be performed at eight major medical centers around the country, but Prof. Natan Bornstein, head of the stroke unit at Tel Aviv Sourasky Medical Center and chairman of the society, said Israel needs to invest much more in specialized stroke units at additional hospitals, including not only more trained vascular neurologists but other trained personnel who would be on duty around-the-clock, as well.
Prof. Jeffrey Saver, head of the stroke center at the University of California at Los Angeles will speak on thrombectomy at a meeting of the Neurology Society at Tel Aviv’s Sheraton Hotel on Tuesday.