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Why mechanical thrombectomy is a powerful, yet often underutilized, form of stroke treatment

1 month ago 21
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Each moment we are given holds possibility. Yet, every 40 seconds a person suffers from a stroke, which can take away that promise of possibility. Millions of Americans and their families are affected each year by this neurovascular event that can cause chronic disabilities and immeasurable strain on the lives of those impacted.

Every minute during a stroke, 1.9 million brain cells are lost – making it critical to seek treatment right away. Time is brain cells and the lag time to receiving treatment directly impacts a person’s healthcare options, as well as how well their brain, arms, legs, speech or thinking are able to recover. Acting “F.A.S.T” at the first signs of stroke is key part of treatment. While many are familiar with the acronym for identifying stroke symptoms – which stands for face weakness, arm weakness, speech problem, and time to call for emergency help – they may not understand the important relationship between a stroke and the time it takes to receive care.

Prevention and stroke treatment options 

Strokes are the leading cause of death globally and account for an estimated 140,000 deaths in the United States each year. However, even with these alarming numbers, up to 90 percent of strokes can be prevented. Many risk factors for stroke can be controlled before they cause problems, including high blood pressure, smoking, diabetes, obesity, lack of exercise and medications. Treating atrial fibrillation (AFib), or an irregular heartbeat, is also important, as it associated with a five-fold increased risk of ischemic stroke. This is because an irregular heart rhythm can cause clots to form, which can then travel to the brain and block blood flow causing a stroke.

As physicians, it’s important we educate our patients and their caregivers about these ways they can reduce their risk for stroke, as well as treatment options for when one does occur. Over the past decade, advancements in stroke research have led to innovative treatments, like mechanical thrombectomy. Mechanical thrombectomy is a minimally invasive procedure that offers positive benefits to ischemic stroke patients – which account for 85 percent of all strokes – in the first few hours after stroke onset.  However, while mechanical thrombectomy has transformed first-line stroke treatment, it is often underutilized.

The critical impact of mechanical thrombectomy 

Mechanical thrombectomy helps improves the chances a patient will survive a stroke and make a full recovery, with more than half of mechanical thrombectomy patients regaining functional independence.

During a mechanical thrombectomy procedure, catheters are inserted into the femoral artery in the groin and threaded all the way through the arteries to the neck and brain until it reaches the blood clot that has caused the stroke. Then, a stent-like clot retriever is inserted through the catheter, deployed, and is then ‘retrieved’ or pulled backwards to remove the clot and reopen blocked arteries in the brain.

While mechanical thrombectomy can be a lifesaving treatment, not all procedures are created equal. When the procedure achieves substantial or excellent restoration of blood flow to the brain from the first pass, patients experience the greatest benefits. A recent study on the “health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy” — by a company in which I am a consultant was published in the Journal of NeuroInterventional Surgery. It  highlighted the results of this First Pass Effect (FPE), including:

  • Reduced risk of blood vessel injury and irritation, lower rate of procedure complication, and shortened procedure time
  • Significantly earlier hospital discharge, with length of stay reduced from almost 10 days to six
  • Potential per-patient cost savings during the critical care phase in the hospital (starting at $6,575)
  • Beyond hospitalization, additional cost savings are projected in the first year after stroke (starting at $4,116)

Increasing utilization of mechanical thrombectomy 

While mechanical thrombectomy is considered an excellent treatment option for ischemic stroke, it is drastically underutilized as a first line treatment for stroke, with less than 20 percent of Americans having direct access to centers that can perform the procedure.

Ideally, all stroke patients should be treated at a Level 1 stroke center, which offers a full spectrum of neuroendovascular care and has specialized care teams available 24 hours a day, seven days a week. However, many patients are not sent to these centers because rules and protocols for triaging and transporting patients to facilities that can treat the complexities of stroke are out-of-date or nonexistent in many states.

A similar comparison is how trauma patients are triaged and treated. In these situations, first responders evaluate a patient and if the injuries are severe, the patient is immediately sent to a Level 1 trauma center, versus the nearest hospital. These specialized centers have trained teams that deal specifically with trauma, making sure patients get the proper level of treatment they need.

This same level of specialized triaging and care should be applied to stroke centers. By standardizing triage and transport protocols across the U.S., access to mechanical thrombectomy can be increased, and in turn drive down the number of stroke deaths and improve the quality of life for stroke survivors. Advocacy organizations, like Get Ahead of Stroke, have been working to educate the public and policy makers on the importance of stroke center designations.

Don’t wait – Every second counts

All members of the healthcare community – from healthcare professionals to patients to emergency responders – must work together to raise awareness around stroke prevention and the importance of timely treatment. When people are empowered to act immediately on the first signs of stroke, care teams can act quickly with the best technology. Even during times of crisis, like the Covid-19 pandemic, it is critical not to delay care.

If you or a loved one experience signs of stroke, seek help immediately from emergency medical services. With stroke, time means brain cells and every second counts. The faster a lifesaving treatment like mechanical thrombectomy is received, the greater the chance of survival and ability to return to life without disability.

Photo: Jolygon, Getty Images.

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