Dr. Biller is Co-Author of Stroke Guidelines| News | Loyola Medicine
Monday, July 6, 2015

American Heart Association / American Stroke Association issues new guidelines written in part by Loyola’s Dr. José Biller

MAYWOOD, Ill. – New devices called stent retrievers are enabling physicians to benefit selected patients who suffer strokes caused by blood clots. The devices effectively stop strokes in their tracks.
 
For the first time, new guidelines from the American Heart Association/American Stroke Association recommend the treatment for carefully selected patients who are undergoing an acute ischemic strokes and who meet certain other conditions.

Loyola University Medical Center stroke specialist José Biller, MD, is a member of the expert panel that wrote the guidelines, published in the journal Stroke. Dr. Biller is chair of the Department of Neurology of Loyola University Chicago Stritch School of Medicine. Lead author is William Powers, MD, neurology chair at the University of North Carolina at Chapel Hill.

About 85 percent of strokes are ischemic, meaning they are caused by clots that block blood flow to the brain. Treatment with the intravenous clot-busting drug tissue plasminogen activator (tPA) can restore blood flow before major brain damage has occurred, provided the drug is given within 4.5 hours of the onset of the stroke. But in many patients, intravenous  tPA alone is not sufficient to restore blood flow. In such cases, mechanical devices deployed with catheters can be used to remove the clot from a cerebral artery.

The latest mechanical device is a stent retriever. The device is a self-expanding mesh tube attached to a wire, which is guided through a catheter. The physician inserts the catheter in an artery in the groin and guides it through various blood vessels up to the blood clot in the brain. The stent retriever 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 physician removes the catheter. This technique is known as an endovascular treatment.

Dr. Biller said intravenous tPA remains the first-line therapy for treating appropriate  patients with acute ischemic strokes. “In carefully selected patients, endovascular treatment with a stent retriever can provide additional benefit,” Dr. Biller said.

After reviewing results of five recent randomized clinical trials, the AHA/ASA expert panel recommended endovascular treatment for patients who are at least 18 years old; have suffered an acute, severe ischemic stroke; have a clot blocking a large artery supplying blood flow to the anterior circulation of the brain; and meet other criteria.

The guidelines say endovascular treatment is quite effective if begun within six hours of the onset of an acute ischemic stroke.

“Time is brain,” Dr. Biller said. “In the right patient, treatment with intravenous tPA and a stent retriever potentially can reduce stroke damage significantly. Every effort should be made to treat these patients as early as possible by a multidisciplinary and integrated team of experts.”

Stroke symptoms vary. Among other symptoms, they include:

  • Loss or blurring of  vision in one eye.
  • Weakness or numbness of the face, arm or leg.
  • Loss or slurring of speech.
  • Sudden, unusual or severe headache.

If any of these symptoms are present, call 911 immediately, Dr. Biller said.

F.A.S.T. is an easy way to remember the sudden signs of stroke:

F Face drooping.
A Arm weakness.
S Speech difficulty.
T Time to call 911.

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.