Northwestern Medicine Neurologists Determine Best Treatment for Severe Stroke Cases
Northwestern Memorial Hospital May 05, 2015
FDA has only approved one treatment for ischemic strokes –tPA. When given it time, tPA can unblock blood clots and aid recovery. But what about patients who don’t get tPA in time?
For many patients, that treatment is tissue plasminogen activator, or tPA. tPA is the only FDA approved treatment for ischemic strokes and works by dissolving the clot and improving blood flow to the brain. If administered within three hours (and up to 4.5 hours in certain eligible patients), tPA may improve the chances of recovering from a stroke. However, a significant number of stroke victims do not improve even with tPA, or cannot get tPA because they arrive at the hospital too late. Sometimes, the clot is too large for tPA to dissolve on its own.
A team of Northwestern Medicine stroke neurologists analyzed recent developments in acute stroke treatment for patients in whom tPA is not enough to open the blocked artery. In the April 14, 2015 issue of The Journal of the American Medical Association, the Northwestern Medicine stroke researchers reviewed new studies that show improved outcomes for these most severe stroke patients when clots are mechanically removed from arteries using a catheter to perform a procedure called thrombectomy.
Thrombectomy has been performed for many years in emergency situations when tPA could not be administered, but there was uncertainty about whether or not the procedure was effective. The landscape has changed dramatically in the last few months, with six large randomized trials showing that thrombectomy, with or without tPA, dramatically improves outcomes in patients with large clots in brain arteries. The JAMA article written by the Northwestern Medicine group encourages medical centers to adopt this therapy or build alliances with hospitals that can perform this procedure, so that it becomes the new standard of care for stroke patients. JAMA is one of the most widely read journals in medicine, and the review is expected to contribute to a major shift in practice.
This is good news for the most critical stroke patients, said Richard Bernstein, MD, PhD, director of the stroke program and telestroke at Northwestern Memorial Hospital. Bernstein, along with Northwestern Medicine stroke neurologists Shyam Prabhakaran, MD and Ilana Ruff, MD, authored the study.
“We now can confidently treat acute stroke patients with a procedure that dramatically improved outcomes compared to intravenous tPA alone,” said Bernstein, who is also a professor of neurology at Northwestern University Feinberg School of Medicine. “However, it’s important for patients to know that this is a complex procedure requiring a high level of technical expertise. It can only be done at a top tertiary care center like Northwestern Memorial Hospital.”
Northwestern Medicine has used thrombectomy for years and has a large team that specializes in this procedure. Prior to the recent research, it was performed only when established, standard of care therapies could not be used. However, now they expect to offer this treatment to a wider population of patients as a routine therapy, based on the new research.
“These findings represent a major shift in stroke treatment,” said Prabhakaran, who is also an associate professor of neurology at the Feinberg School. “Compared to intravenous clot-busting drugs like tPA, mechanical removal of the clot results in up to 70 percent of patients living independent lives after major stroke, which is double the percentage seen with tPA alone. This means less disability from stroke, less costs related to rehabilitation, home care services and loss of productivity.”
About 87 percent of strokes that occur in the United States are ischemic strokes, caused by an obstruction within a blood vessel supplying blood to the brain. In the absence of oxygen, the brain cells in the immediate area begin to die.
“When patients come to our emergency department with stroke symptoms, they are quickly evaluated by a neurologist to determine if they are a candidate for acute therapy," added Ruff, who is also an assistant professor of neurology at the Feinberg School. “In the past two years, we have dramatically improved our process and we now consistently treat patients with IV tPA in less than 30 minutes from their arrival to Northwestern Medicine Memorial Hospital. We have already updated our protocol so eligible patients can be treated as quickly as possible with mechanical thrombectomy."
Understanding risk factors and learning to recognize symptoms can potentially save lives and limit damage if a stroke occurs. By taking a quick health survey, you can learn about your personal risk factors with our online Stroke Risk Assessment. For more information visit the Northwestern Medicine Stroke Program or to find a physician, please call 312.926.0779.