Stroke: life-saving corkscrews

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MunichIn a severe stroke, a blood clot blocks a large cerebral artery. Medicines that dissolve the plug often do not work well enough. The life-saving solution can then be a special catheter that can be used to pull the clot out of the bottle like a cork.

"Neuroradiologists have been trying to remove blood clots mechanically using catheters for about eight years," explains Professor Joachim Röther, chief physician at the Asklepios Clinic Altona. “The blood clot is pulled out of the artery by means of a basket-like wire mesh, a stent.” Stent retrievers are what doctors call these constructions. The method had repeatedly achieved spectacular successes, but for a long time there were no studies that sufficiently substantiated this.

Greatly improved chances

That has now changed: three studies recently presented have shown how successful the process is. In them, half of the stroke patients received the standard therapy, drug thrombolysis. The stent retriever was also used for the other patients. Thanks to the combination therapy, their chances of a favorable treatment result improved by 20 to 30 percent. "The treatment could not avoid all disabilities, but three out of five patients regained their functional independence," explains Röther.

Adjust supply

Around 10,000 people with a severe stroke in Germany could be saved from permanent disability and death every year, provided that the experimental therapy were used across the board. The experts from the German Stroke Society (DSG), the German Society for Neurology (DGN) and the German Society for Neuroradiology (DGNR) agree. They are now calling for the acute stroke treatment in Germany to be optimized accordingly.

For the majority of patients, the treatment does not change - they can be helped sufficiently with clot-dissolving lysis therapy within a time window of 4.5 hours after the cerebral infarction. For particularly severely affected patients (five percent) with large clots, the stent retriever can mean a difference between life and death, severe disability or independent living. (cf)

Sources:

Joint press release by the German Stroke Society (DSG), the German Society for Neurology (DGN) and the German Society for Neuroradiology (DGNR) February 16, 2015

M. Goyal et al .: Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke, The New England Journal of Medicine, published on February 11, 2015, at NEJM.org.

B.C.V. Campbell et al .: Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection, The New England Journal of Medicine, published on February 11, 2015, at NEJM.org.

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