Researchers Find Ways to Treat Ischemic Stroke Patients and Save More Lives
Researchers at Yale University recently found ways to treat patients with stroke, which may otherwise be considered untreatable.
In research, the Journal of Neurosurgery published, principal investigators Yale associated professor of neurosurgery, Charles Matouk, MD, and neurology associate professor, Nils Petersen, MD, Ph.D. found that an approach known as a direct carotid puncture or DCT provides a life-saving and astonishingly "safe alternative to the standard mechanical thrombectomy" for individuals who have "difficult-to-access arteries."
Reports related to the finding indicate that Americans have over 795,000 occurrences of stroke each year, resulting in 140,000 deaths yearly. Relatively, options for treatment rely on the time the stroke patient is taken to the hospital.
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For the most severe stroke subtype that resulted from a blood clot that blocks a major artery in the brain, doctors struggle to combine tPA with thrombectomy, a process where a stent is used to eliminate the clot that causes the stroke.
The 'Tissue Plasminogen Activator'
As indicated in this study, patients can get "tissue plasminogen activator or tPA," a type of protein, breaking down blood clots during the first four hours-and-a-half from the onset of stroke.
However, after that, the study authors explained, "It is too late for tPA" since the danger of bleeding turns too high.
For the most severe stroke subtype that resulted from a blood clot that blocks a major artery in the brain, doctors struggle to combine tPA with thrombectomy, a process where a stent is used to eliminate the clot that causes the stroke.
Specifically, surgeons take the stent to the brain by threading a catheter through the artery of, typically, from the groin. Furthermore, while this is effective in many conditions, researchers said, it can be a long and complicated journey.
According to Dr. Matouk, the blood vessels turn out to be more twisted like a tree's knots as people age. More so, it turns out to be harder to "navigate up to the head."
The lead investigator added, for roughly five to 10 percent of the patients with stroke, this problem with artery anatomy makes mechanical thrombectomies almost impossible.
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The DCT as a Rescue Tactic
Dr. Matouk also said DCT would enable doctors to access the clot faster and avoid an abnormal vascular system. However, this procedure had long been regarded as more dangerous as compared to other methods of performing a thrombectomy.
The own positive experiences of Matouk doing DCT as a rescue tactic when other procedures did not succeed inspired him and Dr. Petersen to observe the technique closely.
For this particular research, the two investigators observed the tried thrombectomies at the Yale-New Haven 2015 to 2018 to compare people who had procedure aborted due to their arteries' anatomy with those who got a DCT-enabled thrombectomy.
The findings were promising. Doctors could complete 19 of the 20 DCT procedures they attempted to do. Of this population, 84 percent or 16 of the patients had successfully removed clots.
In general, the DCT patients were found to have done better compared to the 17 patients who were not given thrombectomy, which includes getting better scores on the assessment scale for stroke, which the National Institute of Health set out.
Promising Data
Dr. Peterson said their data are quite encouraging. He added, "They show us that not only are we able to use" this rescue tactic safely, but they were able to get the clot and open the blood vessel, too. Furthermore, the study showed that apparently, people had better results than if nothing is done.
The research team used past literature to report their method and adjust to improve safety, including opting for a perforation site "low on the neck," utilizing ultrasound as a guide, and preventing bleeding through pressure application. Such changes have been formalized into the regular workflow for the Yale investigators.
With further research, the investigators suggested, DCT could become a part of the standard of care, particularly for ischemic stroke everywhere, providing more hope for older individuals suffering from the condition.
Commenting on their latest work, Dr. Petersen said, "They know the natural course of this disease is just devastating." He also said this scheme provides new hope for patients to restore function when they would otherwise unavoidably experience "massive, permanent strokes."
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Oct 13, 2020 07:40 AM EDT
