Stroke Therapy Thrombectomy should be introduced quickly

A new stroke emergency therapy is intended to protect patients with a large blood clot in the brain from permanent disability. According to the German Stroke Society (DSG), studies have shown that thrombectomy is promising. In this treatment, the treating physicians pull the blood plug by catheter from the vessel. This is, the study results, in certain cases, a complementary method.

The German Stroke Society (DSG) demands that this endovascular therapy be made available across the board. Specialized stroke units offer a sound basis for this, according to the DSG, but need additional expertise.

There are currently 264 DSG-certified Stroke Units in Germany - specialized units in clinics specializing in the care of patients with strokes. Of these, 99 supra-regional Stroke Units are equipped with more technical and personnel resources and support the remaining 155 regional Stroke Units. "Stroke patients who reach a Stroke Unit in Germany in good time receive treatment at a very high level today," explains Professor Dr. med. med. Darius Nabavi, Chief Physician of the Neurological Clinic at the Vivantes Hospital in Berlin-Neukölln: "In about ten to fifteen percent of patients, we try to dissolve the blood clot by infusing a drug in the arm vein." But this does not succeed in very large clots, so in patients with particularly severe strokes. "Endovascular thrombectomy, which uses a catheter to pull the clot out of the cerebral artery, is therefore a much needed supplement for those who have been hit hard," says Professor Nabavi, who heads the Stroke Unit Commission at the DSG. The expert estimates that in Germany every year about 10 000 patients are eligible for the treatment.

The new method, which is also called "mechanical recanalization", however, makes special demands on the equipment and training of the medical staff. So-called neuro-interventionalists need to perform the catheter-based procedure. "We have been ensuring since 2012 that every certified supraregional stroke unit has at least two neuro-interventionalists available on site," says Professor Nabavi. "The current studies now prove that the structural preparatory work we have done with this certification criterion is correct and important." Over the past few years, many supraregional stroke units have ensured catheter treatment for as many patients as possible through cooperation in networks. In metropolitan areas, suitable patients are already frequently being transported to a specialized neurocenter with a supraregional stroke unit. However, these structures are not yet well developed in rural areas. Overall, the DSG expert expects the number of interventions to increase as a result of the new study results. "The personnel structure of the national stroke units and neuro-interventional teams must therefore be further strengthened," says Professor Nabavi.

The new treatment requires great expertise. "We need quality assurance here, which ensures that no wild growth occurs," says Professor Nabavi. As an instrument of quality assurance, he proposes the Neurovascular Networks (NVN), which have formed in Germany in recent years. These conferences of neuromedicine and vascular experts should in future provide the necessary knowledge and skills in the application of the special procedure. Certification criteria should also ensure the structure and quality of the NVN. In the middle of 2015, the DSG will also update the certification criteria for regional and national Stroke Units. Professor Nabavi: "We want to quickly create the organizational conditions for a nationwide use of catheter-based vascular interventions in Germany."

What the new study for stroke care means, how to ensure the quality and availability of the new treatment, and what new requirements this entails for certified stroke units, experts will discuss together with two patients on 6 May 2015 at a press conference on the "Day against the stroke "(May 10, 2015) in Berlin. (sb, pm)

Proof: Michael Bührke / pixelio.de