STROKE CARE: EXPANDING THE WINDOW FOR TREATMENT

BY ANDREA MONGLER

For people who experience a stroke, receiving timely medical care can be the difference between recovery and disability. This is especially true for those who experience the most severe type of ischemic stroke, which happens when a blood clot blocks a major artery in the brain.

DURING A THROMBECTOMY, A SURGEON THREADS A CATHETER THROUGH THE BODY TO THE BRAIN, WHERE IT IS USED TO HELP REMOVE THE STROKE-CAUSING BLOOD CLOT.
Image courtesy of Science Photo Library/A Noor/BSIP

The best treatment option for people who experience this kind of stroke is a thrombectomy, a surgical procedure in which the blood clot is removed from the artery. Until recently, experts believed that thrombectomy could be safely performed up to six hours from the onset of stroke symptoms. This relatively short time window limits the number of people who might benefit from the procedure.

Recently, however, research has shown that thrombectomy performed up to 24 hours after stroke onset is safe and can result in substantial improvements in patient outcomes. “Having this extended window for patients to potentially have their symptoms reversed by this proven treatment is phenomenal,” says Joshua Osbun, MD, a Washington University neurosurgeon at Barnes-Jewish Hospital. He adds, “It’s really important to get the word out—to the medical community and to patients—that even if someone has been having stroke-like symptoms for more than a few hours, thrombectomy may still be an option.”

During a thrombectomy, a surgeon inserts a catheter through a tiny incision, usually in the upper leg, into an artery. The catheter is then threaded through the body until it reaches the brain, where it is used to help remove the blood clot. The surgeon either sucks the clot out with a device called an aspiration catheter or pulls it out with a stent retriever, which looks like a small metal cage that opens up and grabs the obstruction.

Akash Kansagra, MD, MS, a Washington University interventional neuroradiologist at Barnes-Jewish Hospital, says that although thrombectomy has been performed since the mid-2000s, proof of just how effective it is didn’t come for several years. “In 2015, a set of clinical trials proved beyond a shadow of a doubt that thrombectomy was not just effective but extremely effective,” he says.

Then in 2018, two more studies, both published in the New England Journal of Medicine, showed that more patients could benefit from the procedure than previously thought. “In a lot of cases, we see patients get better before our eyes, minutes after a thrombectomy,” Osbun says. “This is one of the most powerful treatments in all of medicine.”