Improved therapy for stroke patients presented

Every year more than a quarter of a million people in Germany suffer a stroke. Those affected usually have to contend with the consequences for a lifetime. A novel intervention in the brain could save many patients from life-long disability. The new procedure has now been presented at a congress.

Therapy could save you from life-long disability
In Germany over a quarter of a million people suffer a stroke each year. Those affected often have to struggle with their consequences for a lifetime. The news agency dpa reports now in a post about a novel therapy that could save thousands of patients from life-long disability. First, a video is reported that the University Hospital Pittsburgh (USA) has put on YouTube. There you can see how the doctor Tudor Jovin asks a man in the corridor of the hospital: "What is your name?" The patient had just had a stroke and is lying on a stretcher. He wants to answer, but can talk again only a few hours after the immediately initiated treatment. Three days later, the patient says, "I could see the words, but I could not speak them." There is no indication that he had suffered a severe stroke. The story of the man is not an isolated case.

Study results presented at congress
This is shown, among other things, by the results of two major studies recently published in the prestigious journal New England Journal of Medicine, which were presented on the same day at a Stroke Congress in Glasgow, Scotland. "That was clearly the dominant theme of the conference," said Professor Hans-Christoph Diener of the University Hospital Essen, co-author of the so-called Swift Prime study, which was also published in the journal. "People applauded during the lectures, that does not happen often."

"Taking Stroke Therapy to a New Level "
The euphoria has to do with the fact that the two studies, together with three other major studies, also presented in recent months in the "NEJM", clearly show that the so-called endovascular therapy can save many stroke patients from permanent disability. "With every positive study, it is even safer that we can raise stroke therapy to a new level," said Diener, who is also spokesman for the German Neurological Society. Tudor Jovin, who participated in both studies, added, "We are on the verge of a revolution in the acute treatment of stroke."

Every third patient remains disabled
Every year, around 260,000 people in Germany suffer an "ischemic" stroke. A blood clot closes a vessel in the brain, and the interrupted blood supply causes nerve cells to die. About a third of patients remain disabled afterwards, for example in the form of paralysis or speech problems. As Georg Kerkhoff, Professor of Clinical Neuropsychology and Head of the Department of Neuropsychology at the University of Saarland, explained earlier this year, some patients suffer from visual-spatial neglect, neglecting everything that happens in the left side of the body. At the time, scientists at Saarland University announced that they had developed a new stroke therapy that would enable them to better perceive their left half of the body.

Restore blood flow in the brain quickly
So far, doctors have been looking to solve the clot (thrombus) by medication to reopen the vessel. But especially with occlusions of large blood vessels that supply large areas of the brain, thrombolysis usually does not suffice. As the new studies show, in such cases, in the case of the large arteries in the anterior cerebral circulation, an additional intervention with a so-called stent retriever can decisively help. In this procedure, which usually takes about 30 to 45 minutes, a neuro-neurologist pushes a microcatheter from the groin through the aorta to the affected blood vessel and then pierces the clot, following the procedure on a monitor. When he then pulls back the sleeve of the microcatheter, a mesh of the finest wire unfolds from the inside outwards and hooks on the thrombus. The physician can now withdraw the blood clot through the vessel and remove it from the body. Ideally, the brain tissue is then perfused again. "It's a race against time," said Jovin. "The sooner you restore blood flow to the brain, the more brain you save and the better the chance for a good outcome."

Little difference in the rate of side effects
It is also reported that in the Swift Prime study, 196 patients either by lot or by traditional thrombolysis or in addition to a maximum of six hours after the onset of symptoms, the catheter intervention. According to the data, 60 percent of the patients had no impairment after 90 days, compared to only 35 percent in conventional therapy. The rate of side effects is said to be little different from that of standard therapy, thrombolysis. "There is no safety problem," explained neuroradiologist Professor Jens Fiehler from the University Medical Center Hamburg-Eppendorf. According to Fiehler, about 20,000 patients with ischemic stroke are eligible for the procedure annually in Germany. Especially those patients benefit, in which large cerebral vessels are blocked and therefore threatened particularly severe disabilities.

Nearly a quarter of German stroke centers are prepared for new therapy
The suspicion is clarified by a computer tomographic vascular examination (CT angiography). Of the roughly 260 German Stroke Units, 60 are prepared for the new therapy. Patients from smaller hospitals would therefore have to be brought to such a center as quickly as possible during ongoing thrombolysis. The Swift-Prime study involved only large centers. There it took on the confirmation of the suspicion by CT Angiografie on average 57 minutes, until the catheter intervention began. In 88 percent of patients, it was reported that substantial blood flow was again achieved.

"Unbelievably good result "
The therapy has already been included in the guidelines for stroke therapy. Professor Joachim Röther of the Asklepios Clinic Altona pointed this out. "The data is so convincing," said the neurologist, "that it required no long discussions." According to the overall situation of the studies, it would be necessary to treat about four to six patients in order to enable a patient to lead an independent life, explained Röther. "In medicine, that's an unbelievably good result." The procedure also pays off for the healthcare sector. The surgery is costly, "but it can save a patient from being bedridden and in need of care for life," says Fiehler. (Ad)

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Picture credits: Jorma Bork