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.

Thursday, April 18, 2019

Procedure Time Proves Vital in Thrombectomy Success

Except for the fact that your definition of success is completely wrong. 100% RECOVERY IS THE GOAL. WHAT THE HELL ARE YOU DOING TO GET THERE?

Procedure Time Proves Vital in Thrombectomy Success

The current standard of care for stroke should also factor in procedure time when considering surgical intervention, according to a study published in the Journal of the American College of Cardiology.
“[Surgeons] will try once to remove the clot,” said Ali Alawieh, MD, Medical University of South Carolina (MUSC), Charleston, South Carolina. “They’ll then try 2, 3, and even 4 times or more hoping for a successful attempt. The idea of [this study] is to quantify that -- to look for a limit where you start doing more harm than good.”
By studying the number of attempts and the amount of time spent performing procedures, Dr. Alawieh and colleagues concluded that the likelihood of completing an endovascular thrombectomy without significantly increasing the risk for the patient decreases dramatically after the first 30 to 60 minutes, depending on the technique used.
By comparing endovascular thrombectomies performed using either stent retrievers (SR) or aspiration (ADAPT), the researchers found that the most important detail to consider was the time spent manipulating the vessel. Conducting the procedure with an SR means it takes the surgeon longer to get to the vessel than with ADAPT, but the factor that influences patient outcomes is the amount of time needed once the surgical team reaches the clot.
Using SRs, the golden time for the procedure is at the hour mark, and using ADAPT, it is 30 minutes.
“We had noticed this trend at MUSC, but we wanted to know if it extended nationally,” said Dr. Alawieh. “As it turns out, it does. After that 30- to 60-minute mark, depending on the procedure, surgeons should pause and reassess if the procedure is worth continuing.”
Prior studies have shown that extending the duration of mechanical thrombectomies past 60 minutes, and more recently past 35 minutes, decreases the chance a patient will show few or no neurological disabilities after 90 days and increases the chance of a post-procedural haemorrhage. The current study supports those findings at a multicentre national level and shows complication rates increase by the minute and were not dependent on the treatment centre.
“Stroke intervention procedures have improved dramatically in recent years, and they are so effective in helping patients, that it’s difficult for the physician to give up on a procedure when it’s not successful,” said Alejandro M. Spiotta, MD, MUSC. “The major impact of this work is that it provides a potential stopping point for surgeons where the procedure can cause more harm than good.”
Reference: http://dx.doi.org/10.1016/j.jacc.2018.11.052
SOURCE: Medical University of South Carolina

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