Stroke Care: New Devices Causing "Paradigm Shift" | Loyola Medicine
Monday, June 27, 2016

New Devices Causing "Paradigm Shift" in Stroke Care

MAYWOOD, IL – New devices called stent retrievers, which effectively reverse strokes, have revolutionized the treatment of certain stroke patients, according to an article in the journal Expert Review of Neurotherapeutics.
 
“Stent retrievers are a major advance in acute ischemic stroke care and will have significant impact on the evolution of stroke systems of care,” according to the article by Loyola Medicine neurologists Rick Gill, MD and Michael J. Schneck, MD. Dr. Gill is the outgoing chief resident and Dr. Schneck is a professor in the Department of Neurology of Loyola University Chicago Stritch School of Medicine.
 
Eighty-seven percent of strokes are ischemic, meaning they are caused by clots that block blood flow to a portion of the brain. In selected patients, stent retrievers can be used to remove such clots. Loyola used stent retrievers on 34 patients in 2015, and 21 patients during the first six months of 2016.
 
A stent retriever is a self-expanding mesh tube attached to a wire, which is guided through a catheter (thin tube). The endovascular specialist inserts the catheter in an artery in the groin and guides the catheter through various blood vessels all the way up to the brain.
 
Once the stent retriever reaches the blockage, the endovascular specialist deploys it. The device pushes the gelatinous blood clot against the wall of the blood vessel, immediately restoring blood flow. The stent retriever then is used to grab the clot, which is pulled out when the surgeon removes the catheter.
 
“With the advent of stent retriever devices, there has been a paradigm shift in the utilization of endovascular therapies for acute ischemic stroke,” Drs. Gill and Schneck write. (Endovascular refers to catheter-based surgery.)
 
Drs. Gill and Schneck describe how the current generation of stent retrievers, including the TREVO and Solitaire devices, are a remarkable improvement over earlier devices such as MERCI and Penumbra that employed different technology. Studies of these earlier devices showed results that were equivocal at best. But more recent trials of stent retrievers consistently show the newer devices are clearly superior to the intravenous drug tissue plasminogen activator (tPA) alone in reducing disability from strokes.
 
The clot-busting drug tPA can restore blood flow and limit stroke damage, if it is given within 4.5 hours of the onset of the stroke and the clot is small enough. (If the patient is older than 80, the cutoff time is three hours.) But in many patients, tPA either would not be safe to take, or would not be sufficient by itself to restore blood flow. In such patients, stent retrievers often can be used to remove the clot.
 
Drs. Gill and Schneck foresee future device improvements that will do an even better job of restoring blood flow and increasing the number of patients who could benefit.
 
Stent retrievers also will affect where stroke patients are treated. Paramedics will play an important role in routing higher severity stroke patients, who could benefit from stent retrievers, to centers that have the capability to perform neuroendovascular procedures, Drs. Gill and Schneck write.
 
Their paper is titled, “The use of stent retrievers in acute ischemic stroke.”

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.