A game-changer for stroke treatment
Key points
- Stroke is the leading cause of severe long-term disability in the United States, and less than 40 percent of patients who experience the most severe form of stroke regain functional independence if they receive the standard drug intervention alone.
- The Swift Prime study randomly divided patients with severe ischemic strokes into two groups, one receiving IV tPA alone, and the other receiving combination therapy of IV tPA and thrombectomy within six hours of the onset of stroke symptoms.
- However, time remains crucial in stroke treatment.
- Lopes and Conners believe the results of these studies demonstrate the need for a different approach to stroke care.
Stroke is the leading cause of severe long-term disability in the United States, and less than 40 percent of patients who experience the most severe form of stroke regain functional independence if they receive the standard drug intervention alone. Now a study by an international group of stroke physician-researchers has found that removal of the clot causing a severe stroke, in combination with the standard medication, improves the restoration of blood flow to the brain and may result in better long term outcomes.
The findings of the Swift Prime trial (Solitaire With the Intention For Thrombectomy as PRIMary Endovascular treatment) were reported April 17 in the online edition of the New England Journal of Medicine and are scheduled to be published in the journal's June 11 print edition.
"These findings are a game-changer for how we should treat certain types of stroke," says Dr. Demetrius Lopes, surgical director of the comprehensive stroke center at Rush University Medical Center and a co-author of the study. "These outcomes are the difference between patients being able to care for themselves after stroke and being dependent."
Rush was one of the 39 centers in the U.S. and Europe that participated in the Swift Prime trial.
Out, Damned Clot!
More than 795,000 people have a stroke each year, according to the U.S. Centers for Disease Control and Prevention. About 87 percent of these incidents are ischemic strokes, which result from clots in vessels supplying blood to the brain.
The standard treatment for ischemic stroke within the first three to four and a half hours of symptoms is intravenous tissue plasminogen activator (IV tPA), a medication which dissolves the clot. However in the approximately 20 percent of cases in which one of the major arteries is blocked, resulting in a severe stroke, IV tPA alone may not be sufficient to dissolve the clot. If a patient experiencing a severe stroke is brought to a qualified hospital in time, doctors also may be able to perform a minimally invasive procedure called thrombectomy to remove the clot.
During thrombectomy, a neurovascular surgeon threads a catheter through an incision in the patient's groin, snaking it through the blood vessels and into the brain. The doctor then uses a device attached to the catheter to grab and dislodge the clot and pull it all the way out through the incision, a bit like an angler reeling in a fish.
One More Out of Every Four
The Swift Prime study randomly divided patients with severe ischemic strokes into two groups, one receiving IV tPA alone, and the other receiving combination therapy of IV tPA and thrombectomy within six hours of the onset of stroke symptoms. (IV tPA currently is the only treatment for ischemic stroke approved by the U.S. Food and Drug Administration, but the use of thrombectomy is allowed in clinical trials.)
Written and revised by
Andrey Nailor, M.D.
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