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The Stroke Treatment You May Need to Ask For

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A surgical procedure called thrombectomy dramatically improves the odds that many stroke victims will survive and return to independent lives.

Problem: Many hospitals don’t offer it. Compelling evidence for its effectiveness is so new that many aren’t geared up for it yet. But there are ways to make sure you get it if you need it.

Background: Every year, about 800,000 people in the US have a stroke and 130,000 die. The vast majority (87%) of strokes are ischemic—caused by a clot that blocks blood flow to the brain. The go-to treatment offered by virtually every hospital is the clot-dissolving drug tissue plasminogen activator (tPA), given as soon as possible intravenously.

But if the clot is large—a kind often resistant to tPA treatment—a neurosurgeon can do a thrombectomy, a procedure that physically removes the clot. A surgeon uses a device called a stent-retriever to remove the clot from a blood vessel in the brain. This procedure is not brand new, but only in the past few years have studies made it obvious that it often is the best treatment option when a large clot blocks blood flow to the brain. Compared with standard stroke care, this reduces the death rate from 26% to 14%—and patients who survive score 26% higher on a post-stroke independence scale, on average. Recent improvements to the surgical tools
used in thrombectomies likely are increasing survival rates as well. New research finds that the procedure can be effective as long as 24 hours after a stroke—not just six hours, as previously believed—­although the sooner, the better.

What to do: Before you or a loved one has a stroke, get familiar with the “thrombectomy-capable stroke center” nearest to you. This hospital will have undergone a rigorous certification process for stroke care, including this procedure. You can do this by calling area hospitals or searching the database at StrokeCenter.org/trials/centers.

If you or a loved one experiences potential stroke symptoms, call 911. The EMS team should transport the patient to the nearest stroke center if one is close enough, but you can always ask to be sure. Wherever you wind up, ask if the patient is a candidate for a thrombectomy. If the answer is yes but the hospital can’t perform it, ask how quickly the patient can be transferred to such a hospital—by helicopter, if necessary.

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Source: Sameer Ansari, MD, PhD, associate professor of radiology, neurology and neurological surgery at Northwestern University Feinberg School of Medicine, Chicago. NM.org Date: May 15, 2018 Publication: Bottom Line Personal
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