In Kentucky, strokes cause about 5 percent of deaths, and the state had the 11th highest stroke mortality rate in 2009, according to data from the Kentucky Cabinet for Health and Family Services. Fewer than 40 percent of severe stroke victims regain functional independence if they get only the standard drug intervention, but a study has found that also removing the clot both helps restore blood flow to the brain and can lead to more favorable long term outcomes.
"The outcomes are the difference between patients being able to care for themselves after stroke and being dependent," said Demetrius Lopes, surgical director of the comprehensive stroke center at Rush University Medical Center.
The traditional treatment for ischemic stroke—a stroke that involves clots in vessels bringing blood to the brain—is intravenous tissue plasminogen activator (tPA), a medication to dissolve the clot. However, doctors can also perform thrombectomy, a minimally invasive procedure to remove the clot that is allowed only in clinical trials.
In the study, patients with severe ischemic strokes were split into two groups. One group received only tPA, while the other group received tPA as well as thrombectomy. After 90 days, those who received both treatments had less disability and had a functional independence rate of 60 percent, compared to 35.5 percent of those who received only tPA. Also, patients who received thrombectomy had better blood flow rates in the brain.
"Ethically, we can't deny patients a treatment when we have such strong evidence it's better for them," Lopes said. Now thrombectomy is a standard treatment for severe strokes at Rush and some other locations. The study is published in the online edition of the New England Journal of Medicine.