MILWAUKEE, Wisconsin (AP) — Stroke experts are reporting a major advance: Stents similar to the ones used to open clogged heart arteries also can be used to clear a blood clot in the brain, greatly lowering the risk a patient will end up disabled.
Patients treated with these brain stents were far more likely to be alive and able to live independently three months after their stroke, doctors said Wednesday at an American Stroke Association conference in Nashville. The treatment was so successful that three studies testing it were stopped early, so it could be offered to more patients. One study also found the death rate was cut almost in half for those given the treatment.
“This is a once-in-a-generation advance in stroke care,” said the head of one study, Dr Jeffrey Saver, stroke chief at the University of California, Los Angeles.
An independent expert, Dr Lee Schwamm of Massachusetts General Hospital, called it “a real turning point in the field”. For many patients, “this is the difference between returning home and not returning home,” although only certain types of patients can be offered it, he said.
Stroke care “needs to be completely changed” to make the treatment more widely available, said Dr Walter Koroshetz, acting director of the National Institute of Neurological Disorders and Stroke.
“This has taken stroke therapy to the same place that heart attack therapy is now,” he said.
Most of the 800,000 strokes in the US each year are caused by a blood clot lodged in the brain. The usual treatment is clot-dissolving medicine called tPA. When that doesn’t work, doctors sometimes try devices pushed through blood vessels to pluck out the clot, but several studies found they didn’t help.
However, newer devices — metal mesh cages called stent retrievers — open an artery much faster and with less damage to the blood vessel. Unlike heart stents, which stay in place to prop the artery open, the brain stents flatten the clot, trap it and are removed with it.
Two brands are sold in the US — Trevo, made by Stryker Corp of Kalamazoo, Michigan, and Solitaire, made by Covidien, now part of Minneapolis-based Medtronic Inc. They won approval in 2012 based on their ability to remove a clot — not because there was evidence they made patients better.
Last fall, the first solid evidence that these devices helped patients arrived. A study in the Netherlands that tested a variety of clot removers, mostly stents, found these treatments greatly lowered the risk of disability in patients whose clots were not dissolved by tPA.