Doctors use a special device to stent the vessel, then pull the clot out, retrieving the stent at the end of the procedure.
Associate Professor Deidre Anne De Silva describes the new endovascular treatment as a monumental and revolutionary development.
This story was first published in Singapore Health, May-Jun 2016 issue.
Since 1995, patients who get to the hospital within four and a half hours of a stroke can be considered for treatment with a clot-busting drug (tPA or tissue plasminogen activator) given via an intravenous infusion. This gives them the best chance of recovery. Any later than four and a half hours from the onset of symptoms, and it becomes too risky to administer the drug.
Since last year, doctors have been able to offer patients a new minimally invasive treatment called endovascular treatment, which can be rendered in a slightly longer time window – six to eight hours after a stroke strikes.
The treatment involves restoring blood supply by mechanically pulling the clot that is blocking the blood vessel.
Doctors use a special device to stent the vessel, then pull the clot out, retrieving the stent at the end of the procedure.
Associate Professor Deidre Anne De Silva, Senior Consultant, Department of Neurology, National Neuroscience Institute, describes the new treatment as a monumental and revolutionary development. “For something like 20 years, we have not had any new treatment in acute stroke care. Endovascular treatment offers more patients the hope of reducing disability and improving the likelihood of independence following an ischaemic stroke, which is caused by a blockage in a blood vessel that stops blood flow and starves the brain of oxygen.”
An additional one patient will be functionally independent for every three to five patients managed with this new treatment, compared to those who do not receive it.
Prof De Silva said strokes are common, can strike at any age, and have significant consequences. In Singapore, 9,000 new strokes occur each year. It is a leading cause of death and the No. 1 cause of adult disability, with six in 10 patients suffering long-term disability. Statistics show that 85 per cent of strokes are ischaemic and the rest due to primary bleeding in the brain.
Prof De Silva said that an additional one patient will be functionally independent for every three to five patients managed with this new endovascular treatment, compared to those who do not receive it. Endovascular treatment following clot-busting treatment also has greater benefits than treatment with the clot-busting agent alone.
Previously, endovascular treatment was used infrequently and could only be offered on a rescue basis to selected patients. But last year, several international randomised clinical trials revealed clear evidence for its benefit over standard treatment.
“It is now a licensed, guideline-based therapy. So it is a routine practice, rather than given just on a ad-hoc rescue basis,” said Prof De Silva.
But it is still not for everyone. Six out of 10 people who get to a hospital in time are suitable either for endovascular treatment, the clot-busting drug, or both. After running scans and tests, doctors will decide whether patients are suitable for treatment and which would be best for each patient. Endovascular treatment may be given in cases when it is too late or not suitable for patients to get the clot-busting treatment, or it may also be given after the clot-busting treatment.
