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Extra Hours for Stroke Treatment

By Jennifer Johnson

Current guidelines for stroke treatment recommend clot removal only within six hours of the onset of symptoms.

Brain scan of stroke

But a milestone study recently published in the New England Journal of Medicine shows that clot removal up to 24 hours after a stroke led to significantly reduced disability for some patients.

“These findings could impact countless stroke patients who often arrive at the hospital after the current six-hour treatment window has closed,” says co-principal investigator Raul Nogueira, professor of neurology, neurosurgery, and radiology at Emory and director of neuroendovascular service at the Marcus Stroke & Neuroscience Center at Grady Hospital.

The international study randomly assigned 206 stroke victims who arrived at the hospital within six to 24 hours to either endovascular clot removal (thrombectomy) or standard medication therapy.  Almost half of the patients who had clot removal showed a considerable decrease in disability, and had resumed independent living 90 days after treatment. Only 13 percent of the medication group had a similar decrease. There was no difference in mortality between the two groups.

“This does not diminish the urgency with which patients must be rushed to the ER in the event of a stroke,” says co-principal investigator Tudor Jovin, director of the University of Pittsburgh Medical Center Stroke Institute. “The mantra ‘time is brain’ still holds true.”  

To select patients for the trial, the researchers used brain imaging and clinical criteria instead of time alone. “Looking at the physiological state of the brain and evaluating the extent of tissue damage and other factors seems a better way to decide if thrombectomy will benefit patients as opposed to adhering to a rigid time window,” says Nogueira.

The trial was ended early after it was found that clot removal provided significant clinical benefits.

”Our teams are immensely proud of these breakthrough findings, which are so profound they will likely result in a paradigm shift that will not be seen again for many years in the field of stroke therapeutics,” says Michael Frankel, professor of neurology at Emory and director of the Marcus Stroke and Neuroscience Center.

Related Story

"Landmark study may impact standard stroke treatment guidelines" (Nov. 11, 2017)

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