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Extending Window of Opportunity for Stroke Patients

Extending Window of Opportunity for Stroke Patients

Literally every minute counts when someone is having a stroke. The longer that blood flow to the brain is interrupted, the greater the likelihood that brain cells are deprived of oxygen and vital nutrients and progression to permanent damage. Within a short time brain cells die and without prompt treatment the consequences can be devastating. Over 140,000 Americans die each year from stroke. Many of those who survive may experience long-term weakness, memory loss and/or disability.

“There is a short window of opportunity to successfully treat a stroke,” said Ashish Tayal, MD, stroke neurologist and director of the Allegheny General Hospital Comprehensive Stroke Center. “For some patients, certain clot-busting therapies must be administered within three hours of the onset of symptoms to reduce or prevent disability, whereas other patients may need immediate surgery or another form of endovascular (catheter-based) intervention,” he said.

If a stroke is caused by a blood clot in the artery of the brain (called an acute ischemic stroke, which occurs in about 80 percent of all strokes), the patient is evaluated for administration of a drug called intravenous tissue plasminogen activator (tPA), which dissolves the blood clot obstructing the blood flow to the brain. Intravenous tPA is also effective when patients start treatment three- to four-and-a-half hours from the onset of a stroke. Unfortunately, intravenous tPA may not always restore blood flow in the brain and not all patients are candidates for treatment and are then evaluated for catheter-based treatments.

Interventional neuroradiologists at Allegheny General Hospital now offer several advanced, minimally invasive procedures to remove blood clots from the brains of patients suffering from an ischemic stroke—up to eight hours after stroke onset.

AGH neuroradiologists are using the Solitaire F and Trevo retrievable stents (stentrievers) to directly remove clots from brain arteries for select patients with the most severe strokes and in patients not eligible for intravenous tPA. Resembling small tubes with mesh-like walls, stentrievers are inserted through specialized catheters that are passed through a vessel in the groin and then carefully guided into the affected brain arteries via angiography. Upon reaching its target, the stentriever device is opened within the clot to instantly restore blood flow and then the clot is retrieved with the device.

In addition, AGH’s neuroradiologists are using the Penumbra System—a specialized catheter that suctions out the blood clot from the vessel. This procedure also is effective for up to an eight-hour period after the onset of stroke.

“Both the stentrievers and the Penumbra System are sophisticated, technically challenging procedures that should be performed only by the most extensively trained neurointerventionalists,” said Andrew Ku, MD, an interventional neuroradiologist in the Division of Neuroradiology at Allegheny General Hospital. “In the hands of an experienced team of physicians, such as those at the Allegheny General Hospital Comprehensive Stroke Center, patients have a much better chance of recovering from a stroke,” he noted.

Founded in 1988, the Allegheny General Hospital Comprehensive Stroke Center is a designated Primary Stroke Center by the Joint Commission. The center provides both inpatient and consultative care for stroke patients throughout western Pennsylvania and is in the lead position to advance stroke care throughout the hospitals of West Penn Allegheny Health System. Acute stroke care is provided by stroke neurologists (24-hour service) who treat eligible acute stroke patients with tPA and select patients for interventional stroke therapy. Staffed by a highly coordinated, multidisciplinary team of board-certified neurologists, neurosurgeons, and neuro-interventionalists with subspecialty expertise in cerebrovascular disease, the Stroke Center provides comprehensive evaluation, treatment, prevention and rehabilitative services.

In addition to providing care for ischemic strokes, the Comprehensive Stroke Center treats hemorrhagic stroke. This type of stroke occurs when a blood vessel that supplies the brain ruptures and bleeds. When an artery bleeds into the brain, brain cells and tissues do not receive oxygen and nutrients. In addition, pressure builds up in surrounding tissues and irritation and swelling occur. About 13 percent of strokes are caused by hemorrhage.

Through its innovative treatment approaches, the Allegheny General Hospital Comprehensive Stroke Center is making a difference for thousands of people each year. “Every 45 seconds, someone in America is having a stroke, and every three minutes, someone dies of a stroke,” said Dr. Tayal. “Our Stroke Center will help to greatly optimize the chances of survival and recovery.”

To be referred to a specialist at the Allegheny General Hospital Comprehensive Stroke Center, call 412.DOCTORS (412.362.8677).

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