Drexel Neurosciences Institute Neurosurgeon: Data Shows Brain Surgeons Must Re-Think Treatment of "Wake Up Stroke"

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Study Investigator Calls for End of Arbitrary Times Limits

Dr. Erol Veznedaroglu

“We no longer should automatically deny treatment to patients who wake up with stroke symptoms,” said Dr. Erol Veznedaroglu, MD, FACS, FAANS, FAHA, an investigator in the study.

The new generation of retrieval devices that remove blood clots from the brain can be safely used to treat patients with so-called “Wake-Up Stroke,” according to a new study that should change the way neurosurgeons treat people who suffer a stroke while asleep.

The study, published in the Journal of NeuroInterventional Surgery, found that these devices —which require only a small incision in the upper leg where the device is threaded through the arterial system to the brain — are beneficial even if the time of the first stroke symptom is unclear because the patient awoke with symptoms.

“We no longer should automatically deny treatment to patients who wake up with stroke symptoms,” said Dr. Erol Veznedaroglu, MD, FACS, FAANS, FAHA, an investigator in the study. “We need to examine each patient. We cannot rely on arbitrary time limits to tell us when we should intervene to help people experiencing a stroke.”

Dr. Veznedaroglu is the newly appointed director of the Drexel Neurosciences Institute. He also is chairman of the Department of Neurosurgery at Drexel University College of Medicine.

The study was conducted at Capital Health and three other study sites. Because of the unclear time of symptom onset, patients experiencing Wake Up Stroke typically have been ineligible for treatment with these intravenous devices. Stroke is a time-sensitive condition since the typical patient loses 1.9 million neurons each minute a stroke is left untreated, meaning the value of intervention decreases over time while the risks remain.

However, Dr. Veznedaroglu said each patient is different. Instead of solely focusing on the time symptoms began, he said neurosurgeons should intervene when images of the brain, obtained using a specialized CT scan technology called CT Perfusion, show that salvageable brain exists beyond the clot.

The study looked at 52 patients. Forty-six patients, or 88 percent, underwent thrombectomy with the stent retrievers Trevo® or Solitaire FR™. These devices use a catheter containing a wire mesh that is inserted in the groin and threaded through the patient’s arterial system and into the brain.

Once the catheter reaches the clot, it is unsheathed, and the wire mesh immediately expands, creating a pathway to allow blood to flow beyond the clot. The mesh device then becomes entwined in the clot, which is then removed from the brain. The remaining six patients in the study, or 12 percent, were treated with primary aspiration thrombectomy, which uses suction to remove the clot.

Successful recanalization, or the restoration of blood flow beyond the clot, was achieved in 36 patients, or 69 percent. Favorable clinical outcome, at three months, was achieved in 25 patients, or 48 percent of patients.

Dr. Veznedaroglu said neurosurgeons must re-think old guidelines about when to intervene with stroke patients. In the United States alone, 795,000 people experience a new or recurrent stroke each year.

“We have a new generation of interventions, and we can use them to save appropriate patients from severe disability or death. The time windows were perhaps useful years ago, but should no longer completely guide our decision making today,” Dr. Veznedaroglu said.

About Drexel Neurosciences Institute:
Drexel Neurosciences Institute is an innovative collaboration of Drexel University College of Medicine and Global Neurosciences Institute, LLC (GNI). The Drexel Neurosciences Institute, led by prominent neurosurgeon Erol Veznedaroglu, MD, FACS, FAANS, FAHA, provides an integrated approach to neuroscience-related clinical care, education and interdisciplinary research. The Drexel Neurosciences Institute harnesses the expertise of Drexel Medicine neurologists and researchers, who provide groundbreaking care in areas such as Alzheimer’s disease and related dementias, ALS, and chronic pain, combined with the clinical expertise of GNI neurosurgeons, who are among an elite group of dual-trained vascular neurosurgeons able to perform conventional neurosurgery as well as minimally invasive endovascular neurosurgery. Drexel’s primary teaching hospital, Hahnemann University Hospital, is a clinical affiliate of the institute.

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Carol Ann Campbell
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