(Press-News.org) DALLAS, June 29 -- For the first time, the American Heart Association/American Stroke Association recommends using a stent retrieval device to remove blood clots in select stroke patients who have clots obstructing the large arteries supplying blood to the brain, according to a new focused update published in the American Heart Association journal Stroke.
The optimal initial treatment for a clot-caused (ischemic) stroke remains intravenous delivery of the clot-busting medication tissue plasminogen activator (tPA). When given within a few hours after stroke symptoms, tPA can dissolve the clot and reestablish blood flow to the brain, limiting stroke disability.
"What we've learned in the last eight months, from six new clinical trials, is that some people will benefit from additional treatment with a stent retrieval device if a clot continues to obstruct one of the big vessels after tPA is given," said William J. Powers, M.D., lead author of the focused update and H. Houston Merritt distinguished professor and chair of the department of neurology at the University of North Carolina at Chapel Hill.
The focused update on endovascular treatment of acute ischemic stroke analyzes results from randomized clinical trials published since 2013, when the last treatment guidelines were issued.
The clot-removal procedure involves puncturing an artery in the groin and threading a thin wire tube up into the brain until it reaches the blocked vessel in one of the large arteries. At the site of the blockage, the tube with a wire mesh called a stent retriever at its end is pushed into the clot and the mesh is expanded so it grabs the clot, which is removed as the tube is pulled out.
"This additional treatment is more difficult than tPA, which can be given by most doctors in the emergency room," Powers said.
"Clot removal with a stent retriever requires a specialized center, such as Comprehensive Stroke Centers, or other healthcare facilities with specially trained people including some Primary Stroke Centers. This treatment has to be done within six hours of the onset of stroke, so in some areas it can be tricky to get you to an appropriate hospital in time."
The focused update recommends that stroke patients have their clots removed with a stent retriever if they:
have no significant disability prior to the current stroke
received tPA within 4.5 hours of symptom onset
have a clot blocking a large artery supplying blood to the brain
are at least 18 years old
had an acute, severe stroke
have imaging showing more than half of the brain on the side of the stroke is not permanently damaged
can have the procedure start within six hours after symptom onset
The evidence backing this new recommendation received the highest rating based on the scientific evidence reviewed, and suggests the benefits substantially outweigh the potential risks in these patients.
"Evidence-based guidelines are based on clinical trials, which tell you that if you have a patient with the same characteristics of those in the trials, on average they will do much better with the treatment than if you treat them another way," Powers said.
The focused update states that the use of stent retrievers is indicated in preference to other mechanical thrombectomy devices, but notes that the use of mechanical thrombectomy devices other than stent retrievers may be reasonable in some circumstances based on a physician's clinical judgment.
Both tPA and clot-retrieval procedures work better the sooner they are administered. Therefore, it's important to remember the acronym F.A.S.T. and seek immediate help if you notice anyone with the following symptoms:
Face drooping or numbness on one side.
Arm weakness with inability to hold both arms overhead.
Speech slurring or inability to repeat simple sentence.
Time to call 911.
INFORMATION:
Co-authors are Colin P. Derdeyn, M.D., vice chair; José Biller, M.D.; Christopher S. Coffey, Ph.D.; Brian L. Hoh, M.D.; Edward C. Jauch, M.D., M.S.; Karen C. Johnston, M.D., M.Sc.; S. Claiborne Johnston, M.D., Ph.D.; Alexander A. Khalessi, M.D., M.S.; Chelsea S. Kidwell, M.D.; James F. Meschia, M.D.; Bruce Ovbiagele, M.D., M.Sc., M.A.S.; and Dileep R. Yavagal, M.D., on behalf of the American Heart Association Stroke Council. Author disclosures are on the manuscript.
Additional Resources:
Researcher video interview clips, photo, FAST infographic and stroke illustrations and animation are available on the right column of the release link http://newsroom.heart.org/news/clot-removal-devices-now-recommended-for-some-stroke-patients?preview=d67f8c6eef25ea8cff4707126ef7d1ad.
Stroke warning signs
Preventing stroke
Life after stroke
Follow more stroke news on Twitter @StrokeAHA_ASA
Follow AHA/ASA news on Twitter @HeartNews
The American Heart Association/American Stroke Association receives funding mostly from individuals. Foundations and corporations donate as well, and fund specific programs and events. Strict policies are enforced to prevent these relationships from influencing the association's science content. Financial information for the American Heart Association, including a list of contributions from pharmaceutical companies and device manufacturers, is available at http://www.heart.org/corporatefunding.
Women with elevated symptoms of post-traumatic stress disorder consistent with the clinical threshold for the disorder had 60 percent higher rates of having a heart attack or stroke compared with women who never experienced trauma, according to scientists at Columbia University's Mailman School of Public Health and the Harvard T.H. Chan School of Public Health. Results appear in Circulation, the journal of the American Heart Association.
In a survey of nearly 50,000 younger and middle-aged women in the Nurses' Health Study II, 80 percent reported experiencing a traumatic ...
BOSTON (June 29, 2015, 4 pm ET) -- Consumption of sugary drinks may lead to an estimated 184,000 adult deaths each year worldwide, according to research published today in the journal Circulation and previously presented as an abstract at the American Heart Association Council on Epidemiology and Prevention in 2013.
"Many countries in the world have a significant number of deaths occurring from a single dietary factor, sugar-sweetened beverages. It should be a global priority to substantially reduce or eliminate sugar-sweetened beverages from the diet," said Dariush ...
Children of parents who are frequently in conflict process emotion differently and may face more social challenges later in life compared with children from low conflict homes, according to the author of a new study published in the Journal of Family Psychology.
The research study measured brain activity in children who were shown a mix of photos of couples in angry poses, happy poses and neutral poses. Based on questionnaires filled out by their mothers, the children were grouped in either a high conflict or a low conflict group.
When children in the high conflict ...
PITTSBURGH, June 29, 2015 - The immune response that occurs in patients with severe asthma is markedly different than what occurs in milder forms of the lung condition, according to researchers from the University of Pittsburgh School of Medicine. Those unique features could point the way to new treatments, they said in an article published online today in the Journal of Clinical Investigation (JCI).
People with severe asthma, in which the airways become inflamed and constrict to impair breathing, do not get better even with high doses of corticosteroids, the mainstay ...
Baltimore, Md., June 29, 2015 - As the South Korean epidemic of Middle East Respiratory Syndrome (MERS) continues unabated, researchers have raced to find treatments for the deadly virus, which has killed more than 400 people since it was first discovered three years ago in Saudi Arabia.
Now, scientists at the University of Maryland School of Medicine and Regeneron Pharmaceuticals, Inc., have discovered and validated two therapeutics that show early promise in preventing and treating the disease, which can cause severe respiratory symptoms, and has a death rate of 40 ...
Alexandria, Va., USA - Today, the International and American Associations for Dental Research (IADR/AADR) published a case report on the first application of a 3D printed scaffold for periodontal tissue engineering in a human patient, along with a review of 3D printing for oral and craniofacial tissue engineering. These papers are published in the latest clinical supplement to the Journal of Dental Research, which encompasses all areas of clinical research in the dental, oral and craniofacial sciences, and brings emerging contributions in discovery and translational science ...
The goal for many cancer patients is to reach the five-year, disease-free mark, but new research from UR Medicine's Wilmot Cancer Institute suggests that two years might be a more practical survival goal for people with follicular lymphoma.
The difference underscores the fact that about 20 percent of follicular lymphoma patients consistently experience their disease coming back within two years of being treated with the latest therapies--despite the fact that most follicular lymphoma patients can expect to live 20 years.
People who relapse early may have a disease with ...
NEW YORK (29 June 2015) -- There has been much recent discussion in the press of the plight of the so-called "sandwich generation," that is, adults who are responsible for the care of children as well as aging parents. The need for simultaneous childcare and eldercare is a reality that can limit families'--particularly women's--opportunities for paying work.
A new study by social scientists Emilio Zagheni and Denys Dukhovnov for the first time drills down into US statistics about who is providing this care, and who is receiving it. The study found that in 2012, adults ...
WASHINGTON (June 29, 2015) -- As Liberia rebuilds a health care system decimated by the 2014 Ebola outbreak, understanding precisely how far citizens live from health facilities and its impact on seeking care can help shape new strategies to improve health care delivery and reduce geographic disparities.
A new examination of remoteness as a barrier to health care, published online today in the Journal of Global Health, notes that most surveys and policy documents categorize families as living either in an urban or rural setting, and this dichotomy can mask disparities ...
When it comes to the art of persuasion, you can attract more followers if you turn conventional wisdom on its head and stress what you like, not what you do.
A new study, to be published in an upcoming issue of the Journal of Personality and Social Psychology, finds that people are more likely to conform to others' preferences than conform to others' actions. In other words, people want to like what others like, but they want to have or do what others don't have or don't do.
In the study, "Words Speak Louder: Conforming to Preferences More Than Actions," by University ...
