Stroke Treatments
New Procedures Expand Treatment Window for Emergent Stroke
Each year, about 780,000 Americans experience a new or recurrent stroke, according to the American Heart Association and the American Stroke Association, and more than 150,000 people died from a stroke in 2004 - the most recent year with available data.
A pair of leading-edge treatments available at the University of Virginia Health System expands the treatment window for emergent stroke patients for up to six to eight hours, compared with three hours for standard treatments.
The new therapies add to the comprehensive, multidisciplinary care already offered to stroke patients at UVA's Joint Commission-certified Stroke Center, the only certified Primary Stroke Center in the region.
"Emergent acute stroke care and the broad spectrum of treatment options offered by UVA are just not available at most hospitals," says Karen Johnston, M.D., M.Sc., a stroke neurologist and Chair of UVA's Department of Neurology. "We are thrilled to be able to offer additional options that may reverse strokes to our acute stroke patients."
Here's a look at how the new stroke therapies work.
Placing tPA Directly on Clots
Since the 1990s, tissue plasminogen activator (tPA) has been intravenously injected as a treatment for ischemic stroke, proving effective if delivered within three hours of the onset of stroke symptoms.
Now, UVA is one of the few hospitals in the region able to place tPA directly on a clot causing ischemic stroke. Using advanced imaging equipment to locate the clot, UVA's treatment team threads an arterial microcatheter into the brain vessel at the site of the clot and infuses tPA, says Mary (Lee) Jensen, M.D., Professor of Radiology and Neurosurgery and Director of the Division of Interventional Neuroradiology.
Infusing tPA directly to the clot expands the treatment window for acute ischemic stroke patients from three hours after the onset of symptoms to six hours, Jensen says.
MERCI Retriever
While tPA infusion breaks up stroke-causing clots, the MERCI retriever is able to remove clots from the brain. UVA is the only hospital in Central Virginia using the clot retriever, Jensen says.
In a manner similar to tPA infusion, the MERCI retriever is inserted through a catheter placed in the carotid artery. It is navigated past the site of the clot. The retriever, which looks like a corkscrew, is unsheathed and pulled back, grabbing the clot and pulling it into the carotid catheter, which is then removed from the body.
The MERCI retriever can be used to treat acute ischemic stroke caused by a clot for up to eight hours after the onset of symptoms, Jensen says.
Leading-Edge UVA Care Aided by Specialized Physicians, Equipment
While these therapies are important, Jensen says, they're most valuable when paired with a hospital that offers a specialized treatment team and equipment. Care is performed by a collaborative treatment team that includes board-certified stroke neurologists, interventional neuroradiologists, neurosurgeons, emergency medicine physicians and neurocritical-care specialists. A neurosurgeon is always on call in case of a hemorrhage caused by a stroke.
"We have our acute stroke team on call 24/7 every day of the year and they will drop what they are doing - day or night - to get to the patient's bedside in hopes of offering any number of potential therapies to help reverse the patient's stroke symptoms," Johnston says.
Together with 24/7 CT access, UVA also has specialized imaging equipment to help the multidisciplinary team plot treatment for patients. With the aid of CTA and CT perfusion, doctors can quickly determine which portion of the brain is infarcted and which portion is ischemic, helping determine which therapy patients receive.
Performing these interventions can also reveal underlying medical problems that require specialized care, Jensen says, such as an underlying fibrotic clot or stenosis that may require angioplasty or stenting to treat.
Stroke patients receive treatment in UVA's Stroke Unit and Neuro ICU. Studies have shown that treatment in specialized stroke units have several benefits for patients, including lower mortality rates and an increased ability to live at home following a stroke. To aid their recovery, patients also have access to Central Virginia's only Joint Commission-certified stroke rehabilitation center.
To refer a patient for stroke treatment, call UVA Physician Direct at 800-552-3723.