New, improved treatment for strokes

 To begin with, there are two kinds of stroke: 1)  ischemic, which is a clot in one of the brain’s blood vessels that’s blocking oxygen to parts of the brain; 2) hemorrhagic, which is blood flowing where it shouldn’t be, causing brain cells to die. Eighty-five percent of all strokes are the ischemic variety and are the type of strokes I’m talking about here.

The new treatment is called endovascular thrombectomy (EVT). A thrombectomy is the removal of a clot. To perform the thrombectomy, the physician opens the femoral artery in the patient’s groin and threads a microcatheter through the body and up into the patient’s brain. The device grabs the clot and drags it out. In the most successful cases, the patient—who may have been partially paralyzed—recovers within hours. The procedure more than doubles the odds of a stroke patients’ returning to an independent life, and nearly triples the odds of making a complete recovery.

The trick to getting the best results are a combination of quick action, a coordinated effort, and the facilities and expertise to perform the procedure. In the best situations, someone has quickly called an ambulance, and the paramedics are trained to identify the scope of the problem, starting with asking questions such as “Can you smile for me?” and “Can you raise both your arms in the air?” Depending on the answers, the paramedic can determine if the stroke is likely to be a large vessel occlusion, making the patient a strong contender for EVT. (About five to 15 percent of stroke patients turn out to be candidates for an endovascular thrombectomy.) Once in the hospital’s stroke center, specialized teams perform the necessary procedures, beginning with a CT scan to locate the clot.

Traditionally, stroke patients have been treated with clot-busting drugs, which increase the risk of brain bleeds and which need to be given within about four hours of the stroke. Clot-busting drugs improve the long-term outcome for one in three stroke patients. The new, EVT, treatment is superior, but it’s not available everywhere. (John Fetterman had the procedure.)

I was curious to see if our local hospital’s stroke center performed the procedure. First, I went to their website and couldn’t find the information. Then I tried calling, and was never able to reach a person. I went back to their website and finally found, under “excellence awards,” an award for their “endovascular interventions.” Good to know, but I hope I never need the "intervention."

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