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Improving care for patients who suffer large strokes

Article

Patients who underwent a thrombectomy fared better than those who had standard care, a recent study found. The findings offer new insights that could save lives, an Ascension researcher says.

Daniel Gibson, a researcher who works at Ascension Columbia St. Mary’s Hospital in Milwaukee, says the stroke study offers insights that could save lives. (Photo: Ascension)

Daniel Gibson, a researcher who works at Ascension Columbia St. Mary’s Hospital in Milwaukee, says the stroke study offers insights that could save lives. (Photo: Ascension)

Every 40 seconds in the United States, someone has a stroke, according to the Centers for Disease Control and Prevention.

More than 795,000 Americans have strokes each year, the CDC says. but a recent study offers some hope for those who suffer the most severe strokes.

Researchers have found the increased value of thrombectomy procedures following large ischemic strokes. The findings appear in a study published last month in the New England Journal of Medicine.

Researchers at three Ascension hospitals participated in the study. Daniel Gibson, chair of Ascension’s neuroscience service line and principal investigator for the study at Ascension Columbia St. Mary’s Hospital in Milwaukee, discussed the study and its implications with Chief Healthcare Executive®.

The findings offer valuable insights on stroke care that could save lives, Gibson said.

The study examined large ischemic strokes, which are strokes that interrupt the blood flow to the brain. The vast majority of strokes (87%) are ischemic strokes, according to the CDC.

Researchers examined 352 patients who had suffered severe stroke at 31 sites in six countries. Researchers found improved outcomes with endovascular thrombectomy procedures. Such procedures involve surgeons using a device to remove the blood clot.

In the study, researchers found that patients who had thrombectomy fared better after 90 days than those who received traditional care.

Some patients who underwent thrombectomy experienced complications, and the mortality rate was roughly the same for those who received thrombectomy and those who had standard care.

Gibson said via email that the study is significant because it shows that even for patients suffering serious strokes, thrombectomy offers the chance for better recovery.

While most of the study participants were white and male, Gibson said, “the conclusions of the study would be expected to translate into clinical benefit regardless of race, gender, or income.”

Hospitals and health systems of all sizes should find the study useful in improving stroke care, Gibson said.

More hospitals are leveraging system-wide stroke protocols and are using AI software to improve treatment, he said.

Health systems need to have strong procedures in their emergency departments to assess patients who have suffered acute strokes, Gibson said. They need processes to rapidly provide therapies as quickly as possible and, if necessary, transfer patients to facilities where they can get higher-level critical care, including centers offering thrombectomy.

“This trial underscores the need for rapid recognition and management of acute stroke across care sites around the world,” Gibson said. “In 2023, strokes are not only treatable, but curable. Insights gained from this study have the potential to save and improve thousands of lives in the years ahead.”

The findings of the study also offer some promise in improving health equity, Gibson said.

“While this study does not solve the underlying socio-economic issues or delayed stroke care that can have a disproportionate impact on marginalized communities, it does indicate more historically vulnerable patients can and should be offered more effective ischemic stroke treatment with reperfusion therapy,” Gibson said.

However, Gibson stressed the importance of greater public education in underserved populations to understand the symptoms of stroke, and the need to call 9-1-1 if there’s a suspicion that someone is suffering a stroke.

“Public education, coupled with research-backed interventional care solutions, have the potential to advance health equity,” Gibson said.

Ascension had 19 patients participate in the study. Researchers examined patients at Ascension Columbia St. Mary’s Hospital in Milwaukee; Dell Seton Medical Center, part of Ascension in Austin; and Ascension St. Vincent Hospital in Indianapolis.

Researchers wrote that studies of thrombectomy in patients who have suffered large strokes has been relatively limited, since patients often have poor neurologic outcomes, including the progression of stroke symptoms and death.

The study found 20% of the patients who received thrombectomy were functionally independent at 90 days, compared to 7% of the patients who received standard care.

The study was financed by a grant from Stryker Neurovascular to the University Hospitals Cleveland Medical Center and University of Texas Houston McGovern Medical School.


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