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Study: New Treatment Effective for the Worst Strokes

Blausen blood clot
A blood clot, like the type that causes a stroke. Image credit: Blausen.com staff.

News outlets are buzzing, and cerebrovascular doctors are cheering. The cause of all this excitement? A new paper in the New England Journal of Medicine.

The study confirms the observations of Columbia neurosurgeons: there is a cutting-edge treatment that dramatically improves outcomes for patients with some of the worst types of strokes.

The study was conducted in the Netherlands, and articles about it have appeared in the New York Times and the Wall Street Journal.

A stroke happens when a blood clot blocks blood flow in the brain. A clot-dissolving drug called tPA can help if it is administered quickly–within about four hours. When tPA became available, everything changed for doctors and for patients. A new era of stroke treatment was born.

But tPA has its limitations. It can’t usually help with large clots in major blood vessels. These large blockages in big arteries are hard to treat, and cause a lot of damage. They have been considered among the worst types of strokes.

And that’s where the new technology comes in. It’s a thin, delicate piece of equipment called a stent-retriever. The doctor inserts the stent-retriever into a large blood vessel in the leg and threads it carefully through the circulatory system to the problem spot in the brain. Then the doctor deploys the stent, which props the artery open.

Removing a blood clot using a device similar to a stent-retriever
Removing a blood clot using a device similar to a stent-retriever

The stent-retriever has an extra function besides just propping, however. It “grabs on” to the clot. When the device is carefully threaded back out of the body, the clot comes along.

Of course, the process is both delicate and exacting. The doctor must be specially and extensively trained. But in the skilled hands of the right doctor, this stroke treatment is a game-changer. It’s as big of a deal as the clot-busting drug tPA was a generation ago.

And now its benefits have been confirmed by the “gold standard” of medical practice: a large, well-designed clinical study. This means that the observations of scores of doctors have now been rigorously and scientifically confirmed with medical evidence.

Columbia’s Dr. Dorothea Altschul is an expert in using the stent-retriever and other cutting-edge stroke treatments. She has seen firsthand the benefits of the stent-retriever for certain patients, and she is enthusiastic that this study has now been completed and published. “Finally, science has caught up with our vocation!” she says.

Dr. William Christopher Fox, another of Columbia’s experts, agrees. “Those of us who use this technology, have seen results that have now been confirmed by a large clinical trial,” he says. “In selected patients, this technology can be a phenomenal tool to successfully treat stroke.”

In a commentary on the study written for our site, Dr. Philip Meyers, clinical co-director of Neuroendovascular Services, notes another advantage of this treatment. It can be administered within six hours of the onset of the stroke–a significant gain over tPA’s four hours. But, observes Dr. Meyers, there is still work to be done.

“We must continue to work diligently to educate the public about the signs and symptoms of stroke, so medical care can quickly be initiated. [Also,] emergency medical systems must be prepared to rapidly assess stroke victims and immediately transfer them to stroke centers equipped to provide evidence-based interventions.”

“Evidence-based interventions” now includes treatment with the stent-retriever. This treatment should be done only at stroke treatment centers by highly-trained doctors–doctors like Dr. Altschul, Dr. Fox, and Dr. Meyers.

Click here to read Dr. Meyers‘ interesting commentary on the study (which is called, memorably, MR CLEAN).

Click here to read about Dr. Altschul’s recent stroke education program for the general public. (Scroll down in that post for a picture of Dr. Altschul in an operating room, telling her audience about the stent-retriever.)

Read more about Dr. Altschul on her bio page here.
Read more about Dr. Fox on his bio page here.
Read more about Dr. Meyers on his bio page here.

Learn more about the other Columbia Neurosurgery stroke specialists below:

patient journey

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