The Neurosurgical Hybrid Operating Suite at VCU Health (Photo courtesy VCU Health)
You need to act quickly when it comes to dealing with a stroke, but some recent changes in medical technology have given doctors a longer time frame in which to effectively help some patients.
Time is of the essence because it’s estimated that 2 million brain cells are lost with every minute delay in treating strokes. Don’t drive yourself, or have a spouse or other family member take you in: Call the ambulance.
Strokes account for about 140,000 deaths in the United States each year, and killed 3,278 Virginians in 2013. Strokes are the fourth leading cause of death in Virginia and are the No. 5 leading cause of death in America. About 795,000 Americans have a stroke each year.
Clot-breaking drugs used to treat the most common form of stroke, ischemic stroke, have to be administered within 3 hours, or up to 4 1/2 hours of onset in some people. They've proven to be life-savers and increase odds that you won't become disabled. There are also surgical procedures that can be performed to remove clots. Refinements in the procedures have meant that the window for using them have increased from six hours to up to 24 hours in some cases.
In a mechanical thrombectomy, surgeons insert a tube into an artery in the thigh and thread it through the body to where the clot is blocking blood flow in the brain. A stent device is inserted and is used to grab and remove the clot.
John Reavey-Cantwell
“It’s a pretty slick device,” says John Reavey-Cantwell, a VCU Health neurosurgeon and director of its endovascular program for 10 years. He’s performed stroke interventions at VCU since 2008 and notes that there's been a major paradigm shift in the past few years in treating strokes.“It’s a monumental leap in technology," he says.
VCU became a comprehensive stroke center in Virginia in 2015. The facility and also Bon Secours Comprehensive Stroke Center at St. Mary’s Hospital hold Joint Commission Comprehensive Stroke Center certification and perform thrombectomies. HCA Johnston-Willis Hospital is certified as a Comprehensive Stroke Center from DNV GL Healthcare and is a thrombectomy-capable stroke center. The procedure also is available at Memorial Regional Hospital.
David Loy
Patients who may benefit most from this procedure at the later end of the time spectrum have extra blood vessels that can reroute and deliver blood to parts of the brain that aren’t getting blood flow, says David Loy, co-medical director for the Bon Secours Comprehensive Stroke Center at St. Mary’s Hospital. “That part of the brain is still alive and can be rescued by pulling the clot out.”
A scan that shows blood flow and blood volume in the brain helps determine how much tissue shows potential for recovery.
Reavey-Cantwell said the treatment is a life-saver, resulting in up to one in three patients surviving who previously wouldn’t have. Saving the brain tissue may also preserve more function in a patient. They may have less severe outcomes, experience some numbness or weakness instead of paralysis, and are able to function independently instead of needing nursing home care. “You really are changing the course of their lives. It’s amazing,” he says.
Several recent studies have shown the efficiency of thrombectomies in later time frames, most recently in the New England Journal of Medicine. That study reported that use of thrombectomy from 6 to 16 hours after the onset of stroke, in combination with the usual medical therapy in some patients, was better than the medical therapy alone.
The treatments have also gained national media attention, including an informative Wall Street Journal feature.
Loy, who came to St. Mary's in January after working at Swedish Medical Center in the Denver suburb of Engleton, Colorado, says the key is to have the surgery available to everyone.
Reavey-Cantwell suggests a change in how ambulances are routed when it comes to transporting patients who may be suffering a stroke. They usually are taken to the nearest hospital, but he says they should be taken directly to a facility that has the capabilities to perform the mechanical thrombectomy. He also recommends having ambulances equipped with stroke screening capabilities.
Loy says paramedics should be encouraged to call in from the field if they suspect they are dealing with a stroke so a care team can be assembled.
