Time is one of the biggest factors in treating strokes — and a group of South Florida researchers say they’ve found a way to buy stroke patients more time.
If a person has a stroke, the sooner they get treatment, the better their odds are of surviving and of healing without permanent disability. Generally, the thinking has been that patients have a window of no more than six hours for a clot-removal surgery to be effective.
But people don’t always know when they’ve had a stroke — like if it happens while they’re sleeping. And that complicates treatment options.
In a study published in this week’s New England Journal of Medicine, a team of researchers—including doctors from the University of Miami and Jackson Memorial Hospital—describe a new way of using brain scans to identify stroke patients who might still benefit from surgery up to 24 hours later.
The study looked at more than 200 patients with similar kinds of clots that were identified between 6 and 24 hours after a stroke. About half of them got standard care. The other half got surgery. The surgical patients had significantly better outcomes — and far less disability — three months later.
From the article, “A New DAWN for Imaging-Based Selection in the Treatment of Acute Stroke:”
“[O]utcomes for disability were better with thrombectomy plus standard medical care than with standard medical care alone among patients with acute stroke who received treatment 6 to 24 hours after they had last been known to be well and who had a mismatch between the severity of the clinical deficit and the infarct volume, which was assessed with the use of diffusion-weighted MRI or perfusion CT and measured with the use of automated software.”
An editorial that was published alongside the study cautions that time is still essential, but it offers qualified optimism:
“These imaging-based approaches represent a new “DAWN” for the selection of patients who are likely to benefit from thrombectomy that is performed far longer after the onset of stroke than current guidelines suggest, at least among patients who have severe stroke, vascular occlusion, and penumbral tissue. … For those patients, late thrombectomy works — but as of now, as far as we know, it works only for them.”