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Brain stent offers new treatment option for stroke victims

June 30, 2015 at 6:25 PM EST
In the United States, strokes are the fifth leading cause of death. Most strokes are caused by a blood clot in the brain, which can be treated with a time-sensitive medicine, but few get to the hospital in time. Now, the American Heart Association is recommending a special stent to remove clots. Judy Woodruff talk to Dr. William J. Powers of the University of North Carolina School of Medicine.
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JUDY WOODRUFF: Nearly 800,000 Americans suffer a stroke each year, and 130,000 die from one, making it the fifth leading cause of death in this country.

Most strokes are caused by a blood clot in the brain. The recommended treatment is a drug called TPA, designed to dissolve it. But it must be given within 4.5 hours after the stroke. And fewer than 5 percent of people are diagnosed in time.

Now the American Heart Association has recommended another treatment to help. In many cases, doctors should use a special stent to remove the clot.

Dr. William Powers is the head of the panel that made the recommendation. He’s the chief of neurology at the University of North Carolina at Chapel Hill.

Dr. Powers, thank you for being with us.

First of all, explain what this procedure is. How does it work?

DR. WILLIAM J. POWERS, University of North Carolina School of Medicine: So, the procedure involves making a puncture in a large artery in the groin and threading a small tube called a catheter up through the chest and up through the neck and into the head, and then pushing that catheter into the blood clot.

And inside that catheter is a stent, which looks like a piece of rolled-up chicken wire. You pull the catheter back. The stent expands. It grabs the clot, and then you pull the stent and the clot back out of the brain, and relieve the blockage in the blood vessel and restore blood flow to the brain.

JUDY WOODRUFF: So this is different from the stent that I think many people may have heard of that may be used in a blood vessel in the neck or in the heart that goes in and expands the blood vessel?

DR. WILLIAM J. POWERS: Well, it’s the same type of stent. They do expand. But, in this case, you don’t leave it there.

You actually just use it as a way — as a snare to pull the blood clot out.

JUDY WOODRUFF: Who benefits from this?

DR. WILLIAM J. POWERS: So, there have been now five very, very nice studies that have looked at people who have had this procedure and compared them to people who don’t.

And, by and large, it’s people who have a large clot in one of the large vessels that supplies a large part of the brain, and who have also already received I.V. TPA, but the I.V. TPA doesn’t resolve the large clot, and they have to be treated with this stent within six hours of the onset of their stroke.

JUDY WOODRUFF: So, it would be used with this medicine; is that right?

DR. WILLIAM J. POWERS: Right. In fact, it’s used after I.V. TPA is given primarily.

It might also work with people who haven’t gotten I.V. TPA, but we just don’t have enough evidence to know that as of yet.

JUDY WOODRUFF: And what are the potential complications here?

DR. WILLIAM J. POWERS: Yes, it’s very interesting.

The complications in all of these studies were essentially no more than the people who received I.V. TPA alone, which is a 2 percent to 3 percent risk of hemorrhage from the I.V. TPA.

JUDY WOODRUFF: Right now, are most people treated with this medicine, the TPA?

DR. WILLIAM J. POWERS: Well, unfortunately, most people don’t get to the hospital in time to get the I.V. TPA. And probably 5 percent to 10 percent of people get it. Many, many, many more could if they got to the hospital in time.

JUDY WOODRUFF: So, what do you think this recommendation coming from the American Heart Association is going to make?

DR. WILLIAM J. POWERS: Well, you know, I hope it does several things.

I hope it, more than anything, gets people to understand that there are treatments for acute stroke. We now have a new one that helps even more people. But you have to get to the hospital quickly, which means call 911.

The other thing that I hope it does is, it will allow us to set up systems of care around the country. Not every hospital can do this new stent retriever treatment. So we need ways to get people to local hospitals to get their I.V. TPA and then, if they benefit, to centers who do this treatment.

JUDY WOODRUFF: So, is the Heart Association in the process of making sure doctors get this, physicians get this training?

DR. WILLIAM J. POWERS: So, there are physicians who are trained to do this. And there are training programs set up.

It’s really, I think, a question more of organization than of the Heart Association worrying about the training.

JUDY WOODRUFF: And — but, in any event, what you’re saying is that the word will — is already out, but it’s going to be out even more so now and you’re looking to hospitals to implement this?

DR. WILLIAM J. POWERS: Yes, I think so.

Since these studies were published, I mean, our practice at our hospital has changed drastically. And we have set up a whole new system of care to efficiently take these people in from outside by helicopter, because we can offer the treatment and get them the treatment they need.

JUDY WOODRUFF: Dr. Bill Powers at the University of North Carolina, thank you for sharing all this with us.

DR. WILLIAM J. POWERS: Thank you very much for having me.

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