Thursday, April 21, 2016
NEW HAVEN, CT — Yale New Haven Hospital (YNHH) is one of two Comprehensive Stroke Centers in Connecticut to offer a new form of technology called stent retrievers for the treatment for severe strokes. To remove the clot, doctors thread a catheter through an artery in the groin up to the blocked artery in the brain. The stent retriever opens and grabs the clot, allowing doctors to remove the stent with the trapped clot.
“We were one of the earliest adopters of this major advance in the treatment of the most severe ischemic strokes,” said Ketan Bulsara, MD, associate professor of Neurosurgery and director of the Neuroendovascular and Skull Base Surgery Programs at YNHH.
Each year, more than 690,000 Americans have a clot-caused, or ischemic, stroke. As many as one in four of them have a large-vessel clots.
“The discouraging reality has been that patients who survived large-vessel clots were often condemned to a life of paralysis, speech problems or other significant disability. We’ve been engaged with the stent retriever for a while now and have found our patients are actually getting back to their regular lives. Five years ago, that wasn’t necessarily the case,” said Michele Johnson, MD, professor of Radiology & Biomedical Imaging and director of Interventional Neuroradiology.
People with clots blocking a large vessel in the brain are more likely to survive and fully recover if they have the clot removed by a stent retriever, studies have determined. Experts say qualified stroke centers nationwide are seeing an increase in referrals for stent retrievers.
The last major advance in stroke treatment came almost 20 years ago, when the Food and Drug Administration approved the clot-dissolving drug tissue plasminogen activator, or tPA. For smaller clots, the intravenous drug is very effective, but it often fails to break up large clots.
For these big blockages, tPA probably dissolves the clot less than a third of the time. The stent retrievers reopen the artery 80 to 90 percent of the time. “The procedure is ideally performed within six hours after the stroke starts, and in most cases after the patient receives tPA,” said Dr. Bulsara who was involved in writing the Society of Neurointerventional Surgery (SNIS) guidelines. Stent retrievers are used at all 96 comprehensive stroke centers and some of the nearly 1,100 primary stroke centers certified by the AHA and the Joint Commission, a nonprofit that accredits hospitals.
But both tPA and stent retrievers are time-sensitive treatments that rely on people calling 911 as soon as they notice facial drooping, arm weakness or speech difficulty, some of the telltale warning signs of a stroke. “People having stroke symptoms – or those around them who notice there’s a problem – need to understand that they could have a nearly complete recovery if they only get to the hospital fast enough,” said Charles Matouk, MD, assistant professor of Neurosurgery and of Radiology & Biomedical Imaging, and co-director of Clinical Research.
Yale New Haven Hospital (YNHH), part of Yale New Haven Health, is a nationally recognized, 1,541-bed, not-for-profit hospital serving as the primary teaching hospital for the Yale School of Medicine (YSM). Founded as the fourth voluntary hospital in the U.S. in 1826, today, YNHH has two New Haven-based campuses, and also includes Yale New Haven Children's Hospital, Yale New Haven Psychiatric Hospital and Smilow Cancer Hospital. YNHH has received Magnet designation from the American Nurses Credentialing Center, the nation’s highest honor of nursing excellence. YNHH has a combined medical staff of about 4,500 university and community physicians practicing in more than 100 specialties. www.ynhh.org
