https://www.nytimes.com/2018/01/24/health/stroke-clots-brain.html?rref=collection%2Fsectioncollection%2Fhealth
Many
more stroke victims than previously thought can be saved from
disability or death if doctors remove blood clots that are choking off
circulation to the brain, a new study has shown.
“These
striking results will have an immediate impact and save people from
lifelong disability or death,” Dr. Walter J. Koroshetz, director of the
National Institute of Neurological Disorders and Stroke, said in a
statement. “I really cannot overstate the size of this effect.”
The key finding is that there is often more time than doctors realized in which brain cells can still be rescued by a procedure to remove the clot.
Traditional guidelines have set a limit of six hours after stroke
symptoms begin, and said after that it would be too late to help.
The
study showed that the time window could be expanded to 16 hours.
However, the findings do not apply to every stroke victim. The
researchers used a special type of brain imaging to identify the
patients who still had live brain tissue that could be saved if the
blood supply was restored. Only about half the patients who were
screened qualified for treatment, known as thrombectomy, which uses a
mechanical device to pull clots out of a blood vessel.
The
study, involving 182 patients at 38 hospitals in the United States, was
stopped early because patients who had clots removed fared so much
better than those who did not.
Ninety
days after treatment, 45 percent of the thrombectomy patients were well
enough to be “functionally independent,” as opposed to 17 percent of
those who did not have the procedure. The death rates were 14 percent in
the thrombectomy group, and 26 percent in those whose clots were not
removed.
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The results were published
on Wednesday in The New England Journal of Medicine. The study was paid
for by the National Institutes of Health, and led by researchers from
Stanford University. The Stanford team said it expected the study would
lead the American Heart Association to change the guidelines for stroke
treatment, extending the time window for thrombectomy.
It
is not uncommon for strokes to begin during sleep, and some of those
patients miss out on treatment because it is not clear what time the
stroke began. Medical practice has been to set the beginning of the time
window as the last moment they were known to be well, and if they have
slept most of the night the six-hour window may be over by the time they
wake up. New guidelines may allow such patients to be treated.
About
750,000 people a year suffer strokes in the United States, and 85
percent of those are caused by clots — the same type treated in this
study. Symptoms include speech difficulty, arm weakness and facial
drooping. Experts urge patients or their families to call 911
immediately so that treatment can be started as soon as possible.
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