Deans' stroke musings: Endovascular embolectomy aids minority of stroke patients

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, June 8, 2011

Endovascular embolectomy aids minority of stroke patients

http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?contextCategoryId=40131&ref=25&ts=1307378113381&location=http%3A%2F%2Fwww.modernmedicine.com%2Fmodernmedicine%2FModern%2BMedicine%2BNow%2FEndovascular%252Dembolectomy%252Daids%252Dminority%252Dof%252Dstroke%252Dp%2FArticleNewsFeed%2FArticle%2Fdetail%2F724937&id=724937
Only a minority of patients with acute ischemic stroke will benefit from endovascular embolectomy, new research shows.

"Endovascular clot retrieval can certainly be beneficial in the treatment of selected cases of acute ischemic stroke, but patients undergoing these procedures still have frequent morbidity and mortality," Dr. Harry J. Cloft from Mayo Clinic, Rochester, Minnesota told Reuters Health by email.

"Not more than 1 in 4 patients is discharged home or to a short-term rehabilitation facility after endovascular acute stroke therapy."

Dr. Cloft and colleagues used data from the US National Inpatient Sample from 2006 to 2008 to determine outcomes in 3864 patients treated with endovascular clot retrieval in the general population and to compare data across age strata and between patients treated with and without concomitant thrombolytic therapy.

Nearly a quarter of the patients (24.3%) died in hospital, and more than half the patients (51.3%) were discharged to a long-term facility, they reported online April 14th in Stroke.

In-hospital mortality rates didn't differ significantly between patients who had clot retrieval alone and those who had clot retrieval plus thrombolysis, but significantly more patients who had clot retrieval alone (52.7%) than those who had clot retrieval plus thrombolysis (49.1%) were discharged to long-term facilities.

Combined morbidity and mortality rates didn't differ significantly for patients receiving endovascular clot retrieval alone (76.4%) and for patients receiving clot retrieval plus thrombolysis (74.4%).

The two groups (with and without thrombolysis) didn't differ in any of the secondary outcomes (rates of intracranial hemorrhage, gastrointestinal hemorrhage, gastrostomy, or tracheostomy).

In-hospital mortality rates were significantly lower for patients under 65 years old than for those 65 and older (17.1% vs 29.7%), and rates of discharge to a long-term facility were significantly higher for the older patients (54.1% vs 47.6%).

Significant predictors of morbidity included increasing age, male gender, and Charlson Comorbidity Index. Age group, nonwhite race, and Charlson Comorbidity Index significantly predicted mortality.

"Unfortunately, these disappointing outcomes have been seen in multiple, recent studies of endovascular clot retrieval for stroke, suggesting that substantial work remains to be done to improve outcome in patients presenting with severe, acute stroke," the researchers note.

"Our findings do not directly change who should undergo endovascular embolectomy, but the high proportion of bad outcomes indicates that better patient selection might be prudent," Dr. Cloft said. "Advanced imaging with CT perfusion or MR imaging may help select patients who have not already completed large infarctions and are therefore more likely to benefit from endovascular embolectomy."

Dr. Cloft added, "The Interventional Management of Stroke III (IMS III) is a randomized trial that is underway comparing intravenous thrombolytic therapy with intra-arterial therapy."