A thrombectomy minimizes or prevents disabilities caused by an ischemic stroke, a stroke caused by a large blood clot that cuts off blood supply to the brain. Ischemic strokes account for more than 87 percent of all stroke cases, according to the American Heart Association. During the thrombectomy, the doctor uses an instrument to retrieve the clot. The new guidelines, released at the International Stroke Conference in January 2018, expand the time window when doctors can perform a thrombectomy from six hours, to up to 24 hours.
“It was very exciting and impressive to see the studies reflect these results,” said Marc Lazzaro, MD, FAHA, an interventional neurologist at the Neuroscience Center at Froedtert Hospital. “These guidelines benefit patients when we don’t know what time their stroke occurred, for example, a person who has a stroke in their sleep or who is found down in their home by someone else.”
The new guidelines are the result of several large studies, including DEFUSE 3, a study that enrolled patients with ischemic strokes from six to 16 hours; and DAWN, a study that enrolled ischemic stroke patients from six to 24 hours. Patients were enrolled in the studies based on perfusion imaging scans that showed evidence of salvageable brain tissue. The patients were randomized with either standard medical care (no thrombectomy after the six-hour mark) or care involving a thrombectomy. The studies showed overwhelming benefit using thrombectomy for these patients.
“This means more people can be treated, and their disabilities will be less severe,” Dr. Lazzaro said. “It also means fewer people will be disabled. Right now, stroke is the leading cause of disability in the United States and the fifth leading cause of death. This has the potential to cause a substantial impact, and by reducing disability, it may be able to shift that ranking.”
Dr. Lazzaro reminds people to be vigilant about learning and recognizing the signs of a stroke. Remember BE FAST (Balance, Eyes, Face, Arm, Speech, Terrible Headache – Call 911). While the timeframe for a thrombectomy is longer, this does not change the fact that “time is brain.” Seconds count when responding to a stroke. In an ischemic stroke, the brain tissue is not getting enough blood. It is being kept alive by supporting blood vessels, or collaterals. Those collaterals can fail in a matter of hours, leaving the patient with permanent brain damage.
“It is extremely important that we do not say ‘I have 24 hours to get treatment, I can go to the hospital tomorrow,’” Dr. Lazzaro said. “As soon as you recognize the signs of stroke, you should call 911.”
The Comprehensive Stroke Center at Froedtert Hospital is staffed 24 hours a day, seven days a week, with specialists offering some of the most advanced complex stroke care in the region. This includes a dedicated Neurosciences Intensive Care Unit with staff trained for critical patients.
"Comprehensive Stroke Center" is a certification hospitals receive if they meet the highest standards to treat the most complex stroke cases. Research from the American Stroke Association shows outcomes for patients treated at Comprehensive Stroke Centers are better, including higher quality care, fewer complications and less time in the hospital or in rehabilitation.
Expert Treatment for Stroke
