Clot Removal Procedure Offers Hope to Stroke Patients
Andrew Ringer, M.D.
A sobering statistic from the American Heart Association: A stroke occurs somewhere in the United States roughly once every 40 seconds, killing an estimated 133,000 people annually. The good news? Two Mayfield Brain & Spine vascular neurosurgeons – Andrew Ringer, M.D., and Lincoln Jiménez, M.D. – are expertly trained in performing a breakthrough blood clot retrieval procedure called mechanical thrombectomy, offering hope to those who suffer large-vessel, or ischemic, strokes.
Mechanical thrombectomy, employing a tool called a stent retriever to remove the brain clot, thus restoring blood flow to the brain, not only saves patients’ lives but also significantly reduces the risk of disability, says Ringer, chief of neurosciences for TriHealth. He and Jiménez, a member of the TriHealth Neuroscience Institute, are two of a small number of surgeons in the country trained to perform this revolutionary procedure, which makes it possible for some patients to be treated successfully up to 16 hours after a stroke. Some patients – depending on their conditions based on advanced brain imaging – may have a window of up to 24 hours.
This dramatically expanded window for emergency treatment applies to a small subset of stroke patients who wake up with stroke symptoms or for some other reason do not know when their stroke began, Ringer notes. These patients must have experienced the type of stroke that can be diagnosed with specialized MRI or CT scans that measure perfusion, the passage of fluid through the circulatory system to the brain. This makes sure that a certain amount of the brain tissue fed by the blocked artery is not dead, indicating that a patient can indeed recover once the clot is removed.
Over the last decade, the time limit for successfully treating stroke patients with tissue plasminogen activator (tPA), the standard clot-dissolving medication administered intravenously, gradually grew from three to 4.5 to six hours after the event, Ringer explains. “We wondered, could we go longer? Are there some people who could be treated after six hours? Next came imaging studies measuring brain perfusion. Now we can measure brain perfusion using a special CT scan to measure blood flow to immediately determine if thrombectomy can help.”
After injecting dye into a patient’s arteries to determine where the blood flow is blocked, for example, Ringer then can use a balloon-guide catheter inserted up through a patient’s groin to control the blood flow before using the stent retriever to remove the clot.
Mechanical thrombectomy offers a 75 to 80 percent chance of successful treatment to those patients eligible for the procedure. Ringer emphasizes, however, that a person having a stroke that is deemed too large would not be eligible for mechanical thrombectomy because there is a risk of that treatment making the situation worse, with a very miniscule chance of making things better.
“Not everyone is a candidate [for mechanical thrombectomy], which is why we have specific criteria that determine which patients will benefit from it,” adds Jiménez.
Post-thrombectomy care is just as important as the procedure itself when it comes to a patient’s stroke recovery, he points out. If there is not adequate post-thrombectomy care, a patient may bleed from the affected area of the brain or there may be other negative results involving the artery that was just thrombectomized.
“Post-thrombectomy care entails, among many things, blood pressure management,” Jiménez explains. Imaging, such as MRI or CT scan, is also crucial.
While major advances have been made in stroke patient outcomes thanks to mechanical thrombectomy, Ringer and Jiménez agree that an ounce of stroke prevention is clearly worth more than a pound of cure.
“There are a lot of things people can do, even with a family history of stroke,” Jiménez explains. “Exercise is very important. You don’t necessarily have to be running or biking all the time as long as you are active.”
Adhering to a healthy diet is important, as is keeping up with your regular visits to your primary care doctor, who will evaluate your blood pressure and conduct other lab tests to determine if you have stroke risk factors. If you have high blood pressure, commit to taking your blood pressure medication, Jiménez advises. If you are diabetic, commit to a healthy diet and taking your medications as prescribed.
And don’t smoke. “That includes vaping,” he adds. “Even vaping may lead to creating a risk for stroke.”
Jiménez and Ringer also encourage people to familiarize themselves with the signs and symptoms that indicate you or a loved one is having or has had a stroke. These symptoms, according to the American Stroke Association are:
• Balance – Watch for a sudden loss of balance.
• Eyes – Is there a sudden loss of vision in one or both eyes? Or double vision?
• Face – Ask the person to smile and check to see if one side of the face droops.
• Arm – Ask the person to raise both arms and see if one arm drifts downward.
• Speech – Ask the person to repeat a simple sentence and check to see if words are slurred or the sentence is repeated incorrectly.
If a person shows any of these symptoms, call 911 immediately, the Mayfield neurosurgeons advise. As with all medical emergencies, it’s important to get to the hospital as quickly as possible.
Mayfield Brain & Spine is located at 3825 Edwards Road, #300, Cincinnati, OH 45209. For more information, call 513.221.1100, email firstname.lastname@example.org or visit www.mayfieldclinic.com