Conference News Update—Society of Neurointerventional Surgery
Results showed that while the number of stroke cases climbed across these three time periods from 723,327 to 738,490, the rate of deaths decreased with newer devices. In 2012, stent retrievers were associated with a mortality rate of 17.1% versus preretriever devices in 2008–2011 (19.3%) and 2006–2007 (25%). In addition, the age-specific mortality following stroke intervention decreased with newer devices for patients older than 80 and between ages 65 and 79. In 2012 the mortality rates were 20% and 14.9%, respectively, compared with 25.8% and 20.5%, respectively, in 2008–2011 and 26.3% and 30.2%, respectively, in 2006–2007. These findings are significant because they prove that older patients can in fact benefit from intra-arterial therapy and that age alone is not an exclusion criterion for interventional treatment.
“The introduction of stent retrievers for stroke treatment has been a significant game changer. Not only have these tools provided practitioners with new approaches to treatment, but we have also proven that innovation is worth the investment,” said Dr. Boddu. “With treatment advances, we are seeing increasing numbers of patients survive stroke.”
In a second study, Implementation of New Technological Advances of Endovascular Treatment in Acute Ischemic Stroke Provides Overall Improvement in Procedural Times, which was conducted at the Swedish Medical Center in Englewood, Colorado, the usefulness and performance afforded by evolving devices were again the focus as investigators sought to understand whether newer tools were associated with better outcomes and shorter procedural times. An analysis of data from six prospective and retrospective endovascular treatment trials was conducted. Various evolutions of the Penumbra Aspiration System were used in the studies as the primary therapy. Out of a pool of 932 subjects, study results showed that the newer and larger Penumbra catheters provided a faster and more efficient method for treating acute ischemic stroke. When considering variables including age, baseline NIH Stroke Scale score, and post-treatment status of restoration of blood flow, shorter procedural times were a significant predictor of better clinical outcomes at 90 days, as measured by the modified Rankin Scale.
Donald Frei, MD, lead author of the study, president of the Society of Neurointerventional Surgery, and neurointerventionalist at Swedish Medical Center, echoed the optimistic sentiment espoused by Dr. Boddu. “As each new generation of devices provides improved tools for our treatment arsenal, we are able to adjust our approach to maximize efficiencies and results for our patients. Time is the most important factor when treating a stroke, so it is incumbent upon all of us to use every tool at our disposal to achieve fast and effective treatment,” said Dr. Frei. “Thankfully, each generation of new devices has proven to reduce procedure time, which raises the chance of a successful operation.”
Mobile Stroke Treatment Units May Improve Survival and Recovery From Ischemic Stroke
Mobile stroke treatment units (MSTUs) can significantly reduce the time it takes to diagnose and treat patients for stroke, thus greatly improving survival rates and enhancing a patient’s chance of recovery, according to two new studies.
There are currently four MSTUs in use worldwide. Two are in Germany, and two are in the United States (one in Cleveland and one in Houston). MSTUs resemble ambulances on the outside, but contain highly specialized staff, equipment, and medications for diagnosing and treating strokes. Specifically, they are equipped with diagnostic tools and telemedicine capabilities that facilitate real-time communication with hospital-based stroke specialists, enabling immediate diagnosis and the administration of IV t-PA for eligible patients while en route to the hospital.
“Determining and facilitating the correct treatment in the shortest amount of time is the most important part of treating stroke, as any delay in treatment can be deadly,” said M. Shazam Hussain, MD, Head of the Cleveland Clinic Stroke Program. “Time is never on our side, but it’s clear that MSTUs offer the best chance for patients to receive care as fast as possible, sometimes beginning before the patient even arrives at a facility.”
A trial called Mobile Stroke Treatment Unit and Golden Hour Thrombolysis for Emergent Large Vessel Occlusion: Initial Experience, which was conducted at the Cleveland Clinic, examined patients who received IV t-PA from MSTUs and found that it improved flow restoration rates for emergent large-vessel occlusion (ELVO) strokes that were treated in the “golden hour” following symptom onset. In addition, MSTUs reduced time for qualifying patients to receive intra-arterial therapy for ELVO strokes.
A second study, Triage of Emergent Large Vessel Occlusion Strokes with the Mobile Stroke Treatment Unit, also conducted at the Cleveland Clinic, found that among subjects who received intra-arterial therapy, MSTUs significantly reduced numerous time intervals along the emergency stroke care continuum in comparison with controls, including dispatch to door (19 min vs 31 min), door to initial CT (12 min vs 32 min), and CT to intra-arterial therapy (82 min vs 165 min).
