More patients could be eligible for treatments to remove or dissolve blood clots that cause strokes
Palmetto Health Richland is one of 38 medical centers nationally and the only site in South Carolina that participated in the National Institutes of Health–funded DEFUSE 3 trial. The trial’s results were recently presented at the International Stroke Conference 2018 in Los Angeles, California and simultaneously published in the New England Journal of Medicine because of the implications it has for stroke patients.
The new guideline increases the window of time for select patients who are eligible to have blood clots mechanically removed from vessels supplying the brain. Mechanical clot removal is only advisable in clots that block large vessels. The new guideline recommends that large vessel strokes can be treated safely with mechanical thrombectomy up to 16 hours after a stroke in selected patients. Under certain conditions, based on advanced brain imaging, some patients may have up to 24 hours. This is big news because the previous time limit was only six hours.
Souvik Sen, M.D., chair of Neurology at Palmetto Health-USC Neurology, served as the local principal investigator and Roham Moftakhar, M.D., medical director of Palmetto Health-USC Neurosurgery, served as local principal neuro-interventionalist.
During the procedure, known as a mechanical thrombectomy, a physician uses a device within a catheter to grab and remove the clot. The procedure has proven effective in limiting the risk of disability. Sen said, "Nearly half of the patients who had the thrombectomy procedure were saved from the devastation and disability of the stroke. This is the second randomized trial that has shown impressive clinical benefit of thrombectomy in patients with a large-vessel occlusion ischemic stroke presenting late, after the traditional six hours from stroke onset.”
Moftakhar added, “Results of the study are exciting because we now have an increased window of time for selected patients who are eligible to have blood clots mechanically removed from vessels supplying the brain. Every time we have a chance to help more people prevent the devastating long-term effects of a stroke we are encouraged.”
This increased window of time can prove beneficial for patients whose treatment is delayed due to them experiencing ischemic stroke during their sleep cycle or for being geographically farther away from medical help.
Stroke is the second-leading cause of death in the world and a leading cause of adult disability. South Carolina is in the “Stroke-Belt,” an 11-state region of the United States where studies show that the risk of stroke is 34 percent higher for the general population than it is in other areas of the country. The new guidelines cover acute ischemic strokes, the most common type of stroke, which occur when a blood clot blocks an artery leading to the brain and reduces or stops blood flow.
Even with the new guideline, a person should not delay if they think they or somebody they know is experiencing a stroke.
“Fast action is needed when a person shows the symptoms of a stroke,” warned Sen. “It is better to call 9-1-1 than to have somebody drive a stroke patient to the hospital.”
Signs of a stroke include extreme headache, face drooping, arm weakness and speech difficulty.
“If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately,” said Moftakhar. “Getting to the hospital quickly greatly improves a person’s chances of evading permanent disability.”