Neurological Surgery, P.C.
Events

CLOT-RETRIEVAL DEVICES WIDEN “WINDOW OF OPPORTUNITY” FOR STROKE TREATMENT

New Devices Can be Used Even After tPA No Longer Effective

ROCKVILLE, CENTRE, N.Y., May 10, 2011 – Clot-retrieval devices, used in a catheter-based procedure known as mechanical thrombectomy, can be used safely and effectively up to eight hours after a stroke’s onset.  The devices, which are just beginning to be used in community hospital settings, offer the promise of clearing blocked blood vessels and preventing further brain damage in stroke patients who are outside of the recommended time frame for giving clot-busting medications. 

“Every second counts in stroke treatment,” says neurointerventional radiologist John Pile-Spellman, MD, FACR.  “But when it is too late to give tPA, or when tPA does not work, mechanical thrombectomy can be highly effective.  It is also very useful when blockages are too big to break up with medication.” 

Dr. Pile-Spellman performs mechanical thrombectomies at a number of Long Island hospitals, often working alongside Jonathan L. Brisman, MD, a dually trained endovascular neurosurgeon.  Both physicians are affiliated with Neurological Surgery, P.C., a leading neurosurgical private practice.
Nearly nine of every 10 strokes are ischemic – caused by blockages in the brain’s blood vessels.   A smaller percentage of strokes are hemorrhagic – caused by bleeding in the brain.  When stroke occurs, the disruption in blood flow disrupts the delivery of oxygen to the affected area of the brain.  For every minute that treatment is delayed, additional cellular death occurs.

An intravenous clot-busting medication known as tissue plasminogen activator (tPA) is the standard first-line treatment for ischemic stroke.  This medication carries risks for some patients, and is only effective if given within three hours of the stroke’s onset.  While it is generally effective, it does not always dissolve a blockage, especially if the blockage is large.
“Mechanical thrombectomy represents a major advance in stroke treatment, because it can pick up where tPA leaves off,” says Dr. Brisman.  “This can mean saving precious brain tissue and minimizing long-term damage.”
Mechanical thrombectomy may be done if the patient is seen after tPA’s three-hour “window of opportunity” passes – for up to eight hours after a stroke.  The procedure may also be done if tPA fails to clear a blockage, or in conjunction with tPA, in the case of large blockages. 

Performed in a hospital catheterization laboratory (“cath lab”), a dye is injected and fluoroscopy (x-rays taken in “real time”) guides the clot-retrieval procedure.  Once the blockage is located, a microcatheter is fed into the affected blood vessel.  A tiny wire in the catheter breaks up and brings the blood clot into the catheter.  The catheter and encased clot are then removed.  Studies have shown that mechanical thrombectomy can clear the affected blood vessel about 75% of the time, with four-point improvement on the National Institutes of Health Stroke Scale (NIHSS) seen in up to 65% of patients.  The NIHSS is a standardized method used by physicians and other health care professionals to measure the level of impairment caused by a stroke.

“Only a miniscule number of people who might benefit from these procedures are actually getting them, because they are being done primarily in large academic medical centers,” says Dr. Pile-Spellman.

Patients with ischemic stroke brought to hospitals that don’t perform mechanical thrombectomy receive the current standard of care:  intravenous tPA, when judged appropriate. They may also be transferred to a hospital that performs these procedures, however, this is not ideal as every minute counts following a stroke.

Dr. Pile-Spellman believes that many community hospitals don’t perform mechanical thrombectomies because they would require a properly equipped and available catheterization lab, specialized physicians on staff and on call, and other trained staff who can assist with the procedures.

“I am happy to say that this valuable treatment option is now available on Long Island,” says Dr. Brisman.  “We can deliver the latest, most technologically advanced care right in the community.”

Dr. Pile-Spellman is an international leader in interventional neuroradiology, a field of medicine that uses image-guided catheter-based techniques to treat diseases of the blood vessels of the brain and spine. He joined Neurological Surgery, P.C. from Columbia University Medical Center, where he was vice-chair of research and director of interventional MRI. With more than 150 peer review scientific papers to his name, Dr. Pile-Spellman is actively involved in stroke research.  He chairs the board of directors of H.O.P.E. for Stroke, a nonprofit organization that provides support to stroke victims and their caregivers.
Dr. Brisman was the first endovascular neurosurgeon on Long Island, a subspecialty that combines neurosurgery with interventional neuroradiology. One of only approximately 100 surgeons in the U.S. trained in both endovascular and microneurosurgical techniques, Dr. Brisman authored recent landmark papers in the New England Journal of Medicine and Lancet Neurology on disorders of the brain’s blood vessels.  He has an upcoming book chapter that discusses the latest guidelines on stroke treatment.