New findings could save more stroke patients from disability or death

Many more stroke patients 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 American 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 patient. 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.

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Strokes are the third biggest cause of death after heart disease and cancer in Ireland with just under 2,000 deaths annually. The average age for a stroke in Ireland is 74 and there are about 8,000 new cases of stroke every year.

Last year, the Irish Heart Foundation called for an urgent overhaul of how stroke services are resourced after a European study showed the death rate from stroke in Ireland will increase by 84 per cent in less than 20 years.

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.

The results were published 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 its guidelines.

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.

– New York Times