First-hand Account of Ground Breaking Stroke Treatment

Friends,

Some may find this article to be of interest. I learned quite a bit from it. Lance

Vacuum cleaner for the brain: doctor’s first-hand account of using groundbreaking stroke treatment (theconversation.com)

"Thrombectomy is a revolutionary stroke treatment where the offending clot is literally sucked out of the patient’s brain. I performed my first thrombectomy in 2006, but I remember it as though it was yesterday.. . . "

I wonder to what extent this treatment is available in the USA.

--Lance



Edited 1 time(s). Last edit at 04/11/2019 12:03PM by ln108.

It's been available in the US for a while and has FDA approval. Not sure what the exact timeline was but I see clinical trials dating back to the early 2000s.

It's main limitation at this time seems to be vessel size, meaning it's only useful for large vessel obstructions. Those are the most devastating, often leading to death or a vegetative state, so it's a big advance. For smaller vessels they still rely on tPA if the stroke is recognized and treatment is sought in time. The window of opportunity is only 3 hours, which is why you don't drive to the hospital yourself or let someone else drive you. A suspected stroke should always be an immediate 911 call. Even if you think you can get there faster, what you can't do is raise a stroke alert. Only 911 can do that, and doing that sets all the medical gears in motion before you even arrive. You'll get you into treatment immediately on arrival and bypass all the red tape and delays. If you arrive on your own, you're going to have to run through the whole system of talking to an admitting clerk, providing billing info, being seen by a triage nurse, etc. You can easily lose one of your three hours doing all that, and then more time waiting for radiology, neurology, the cath lab, and whatever else is needed.

Quote
Carey
It's been available in the US for a while and has FDA approval. Not sure what the exact timeline was but I see clinical trials dating back to the early 2000s.

It's main limitation at this time seems to be vessel size, meaning it's only useful for large vessel obstructions. Those are the most devastating, often leading to death or a vegetative state, so it's a big advance. For smaller vessels they still rely on tPA if the stroke is recognized and treatment is sought in time. The window of opportunity is only 3 hours, which is why you don't drive to the hospital yourself or let someone else drive you. A suspected stroke should always be an immediate 911 call. Even if you think you can get there faster, what you can't do is raise a stroke alert. Only 911 can do that, and doing that sets all the medical gears in motion before you even arrive. You'll get you into treatment immediately on arrival and bypass all the red tape and delays. If you arrive on your own, you're going to have to run through the whole system of talking to an admitting clerk, providing billing info, being seen by a triage nurse, etc. You can easily lose one of your three hours doing all that, and then more time waiting for radiology, neurology, the cath lab, and whatever else is needed.

Have a friend who had a stroke 2 years ago. He's been a volunteer ski patroller for 50+ years, so DX'd himself. His wife called hospital and drove him. The hospital had a remote video setup with a stroke doc at the regional hospital with a stroke center. She examined him, they decided on tPA. It was administered, then he was transported via helicopter to the stroke center. Somehow they did not have to go through all the admin stuff. It all worked well and he has no perceptible residual damage. I was at a dinner where he described this a few months after and interestingly one of the guests was a researcher involved in developing tPA.

Quote
GeorgeN
Somehow they did not have to go through all the admin stuff. It all worked well and he has no perceptible residual damage.

Foolish thing for a guy who should know better to do. Maybe being a ski patroller he was known to them or he knew the right things to say, but it's safe to say that's not how it's going to work for regular folks. If he'd called 911 it's quite possible they'd have flown him from the scene directly to the stroke center, thereby cutting off a lot of delay. The other problem with driving someone to the ER is what happens when crap hits the fan halfway there? There's not a thing you can do for them. I've drug people out of cars and done CPR right there on the shoulder of the road a number of times because family was trying to drive them to the ER. Not one of them survived. There was also a case of a local doctor who told an elderly woman to drive her husband to the ER when he came in complaining of chest pain. He arrived dead. The doctor had to undergo mandatory training, be evaluated by another doctor for a month, and and got his license suspended for a period for that.

Driving someone to ER is common in Rural areas. Waiting around for 30 minutes, and then hoping they arrive at that time? Also Ambulance personnel a may not be all that experienced. Sometimes people are transported half-way by Car, then meet up with an Ambulance out somewhere on the Highway. Having grown up in the Country, it is still my 1st instinct to go straight to the ER myself, and not wait around and hope an Ambulance shows up before it's too late.

If you're in remote areas, sure, exceptions might apply, but for the vast majority of people in urban, suburban, and non-remote rural areas driving yourself or being driven is generally a bad idea.