We recently read a very important article featured within the Wall Street Journal. Written by Thomas M. Burton, the article noted, “Leading medical researchers have found that treating many severe-stroke patients as long as 24 hours after a devastating stroke can restore a relatively normal life to some people whose brains had been viewed as badly injured.
In results presented Tuesday in Prague at the European Stroke Organization conference, the research neurologists said that pulling a clot from major arteries to the brain can carry powerful effects many hours later than conventional wisdom had dictated. The study was conducted in 206 patients with serious strokes at 32 hospitals in the U.S., Spain, France and Australia.
“This is the largest treatment effect we have seen” in stroke patients, said Tudor G. Jovin, director of the University of Pittsburgh Medical Center’s stroke institute and the co-principal investigator of the clinical trial.
…stroke doctors were able to lower by 73% the risk that a patient would wind up in a place like a nursing home.
The other co-principal investigator, Raul G. Nogueira of Emory University and Grady Memorial Hospital in Atlanta, estimated that “about 30 to 40%” of the most severe stroke patients “might fit in this new window.”
The research, according to slides at the Prague meeting, shows that stroke doctors were able to lower by 73% the risk that a patient would wind up in a place like a nursing home and be dependent on another person to help in daily activities.
The study employed a clot-retrieval device from Stryker Corp., but other companies make competing products, including Medtronic PLC, Penumbra Inc. and Johnson & Johnson. The investigators’ expenses were paid by Stryker, but they didn’t receive consulting fees. Mark H. Paul, president of Stryker’s neurovascular unit, estimates that about 26,000 cases using clot retrievers are done in the U.S. annually.
Getting stroke patients to treatment as fast as possible has long been essential, and it still is. “Time is brain,” the saying goes in neurology. But it turns out that different patients lose living brain tissue at far different rates, often because of “collateral” arteries that supplement the blood supply from big arteries.
Dr. Nogueira uses the analogy of an intense forest fire. Such a fire can destroy a forest. But different forests burn at different rates depending on factors like wind and water—and can be saved with interventions despite destruction at the fire’s origin site.
For the past two decades, a clot-dissolving drug called tPA was the primary treatment for ischemic stroke, those caused by blockages such as clots. But the drug was useful only for about 4 ½ hours after a stroke. And in part, because people often woke up with a stroke and didn’t know when it happened, tPA’s use was limited. Clot-retrieval devices widened that window to about six hours, but brain tissue has been commonly thought to be dead and irreparably damaged after that.
A handful of specialists like Drs. Jovin and Nogueira, emphasizing the forest-fire analogy, argued that the brain could be saved in many patients much later. They contended that many patients have a “mismatch” between the dead tissue where a stroke started and the far larger territory of brain tissue that is threatened, but still alive.
The doctors began presenting results of individual cases showing success about a decade ago. Their trial began to enroll patients just over two years ago and stopped in March.
When the patients were analyzed, the results were powerful: 48.6% of treated patients could live independently after 90 days, compared with 13.1% of those with standard therapy. Meanwhile, safety comparisons were similar in the treatment group versus the control group”.
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