Transcription:
New Studies Highlight Breakthrough Stroke Treatment

Melanie Cole (Host):  An innovative method of removing blood clots significantly reduces stroke patient’s chances of being disabled, new studies suggest. My guest today is Dr. John Gaughen. He’s a board-certified radiologist who specializes in interventional neuroradiology procedures to treat strokes and other brain conditions at UVA Health Systems. Welcome to the show, Dr. Gaughen. Tell us a little bit about these studies, the recently published studies that examined the type of stroke treatment. What is this treatment?

Dr. John Gaughen (Guest):  Well, Melanie, first of all, thank you for having me on. I’m very excited to be here. Yes, last week, at the International Stroke Conference in Nashville, Tennessee, there were two—really three studies—two that have already been published that has demonstrated very exciting news for the stroke world. Many of the listeners may know there has been a treatment around for about a decade now to help treating certain patients with stroke called mechanical thrombectomy. Simply, what that is, is taking the tube into the blood vessels of the brain, finding the blood clot in the blood vessel of the brain that is causing the stroke and mechanically pulling that blood clot out and restoring blood flow to that part of the brain. Now, we’ve always known that this is a very time-sensitive treatment and only works for patients that have brains that have not completely stroke, so within the first several hours after the stroke onset. It doesn’t apply to all patients. But one of the things that we’ve had a very difficult time in the past doing is demonstrating that this approach to stroke treatment actually provided benefit to patient. What these studies last week showed is they basically confirmed another study that came out over the last fall that showed that in certain patients that have clots in large blood vessels of their brain removed in a timely fashion, those patients showed a much lower rate of disability, a much lower rate of death, than patients treated with our typical conservative treatments, which are blood clot medicines through the vein and other conservative measures. Basically, in a nut shell, what these pieces of literature have done is overnight, made a gigantic paradigm shift in how we’re going to approach strokes in this patient population, which is patients that come in with stroke symptoms that have large clots in large blood vessels of the brain. It is going to change, I think, the way that patients are evaluated and the way patients are treated once they get to the emergency room when they do have an acute stroke. So it’s very exciting information. 

Melanie:  It is very exciting information. Dr. Gaughen, when a patient is admitted and they’re evaluated for stroke situation, how fast can this procedure be evaluated for and then done? 

Dr. Gaughen:  Well, the interesting thing, all of these different studies looked at this disease process in a little bit different way. One study was done in Netherlands, one study was done in Australia, and two of the studies are multinational studies and they all had a little bit different criteria for how they evaluated these patients and determine who was eligible for the treatment. But one thing that they all found was that the faster these patients were identified and the faster they got on to the operating room table to have the clot removed, the better they did. One of the big focuses in the coming months and years are going to be to standardize ways to streamline patients who come to the emergency room to get this treatment as quickly as possible. 

Melanie:  Streamlining that would make it so because with stroke, we know that time is brain and the speed at which you’re cared for really determines that amount of disability you could possibly suffer. As an interventional neuroradiologist, would you be one of the first people in line to see this person and say, “Let’s get them up. Let’s do the mechanical stent.” How does that process work? 

Dr. Gaughen:  Well, the process starts with the first responders. One of the things that we have been doing and we will continue to do is to educate the EMS, Emergency Medical Services, the population in general, that when you identify the symptoms of a stroke, that that is a very time-sensitive issue. When a patient comes in the emergency room, either from family members themselves or from the EMS, we want to know right away if we think that that patient is having a stroke. Typically, at the University of Virginia, we have a stroke neurology service that’s in-house 24 hours a day, seven days a week, and as soon as anybody in the hospital, whether they’re admitted to the hospital or showed up in the emergency department with stroke symptoms, a pathway is begun where the stroke neurologist sees that patient immediately to determine whether they truly think that patient is having a stroke and how bad that stroke is, and how long they’ve been having the symptoms. Once we determine that, we can determine what type of treatment we think that patient is eligible for. If they’re eligible for this type of treatment, meaning they have been having the symptoms for less than eight hours, their stroke symptoms are bad enough that we think that a large blood vessel is blocked and that’s causing the symptoms, that patient will go immediately to the CAT scanner where we do some imaging tests, a CAT scan and a CT angiogram, to look at the brain to make sure that there isn’t something that’s causing the stroke that’s different than what we think, like a big brain bleed or tumor or something that can mimic a blood clot. Then we’d do the CT angiogram which looks at the blood vessels of the brain to see if there is a clot in the location that we can remove. That imaging takes no more than a couple of minutes. Once that patient has got that imaging, we have already, as interventionalists and as radiologists, have already been alerted that there is a patient that potentially has this blood clot. We are looking at those images as they are being processed immediately after they’re taken to make the decision about whether or not that patient is a candidate. If that patient is a candidate, the goal is to get that patient directly from the CAT scanner to the angiography table, where we can place the patient on the table and remove the clot. It is a very time-sensitive procedure, and there are a lot of moving parts between the emergency room physicians, the first responders, the neurologists, the radiologists, and the interventionalists and it takes a very coordinated effort to get that system as streamlined as possible to help patients. What we see is that if you can do that in a quick fashion, we see very good outcomes. We see patients that have significantly reduced mortality and significantly improved functional outcomes when they recover from strokes. It is something that we’re going to see dramatically change, I think, the face of stroke as we know it today. 

Melanie:  Now, in just the last few minutes, Dr. Gaughen, tell us about the risk of this type of thrombectomy and why patients should come to UVA for their stroke care. 

Dr. Gaughen:  Well, like I just said, having a multidisciplinary approach, having physicians that are available in the hospital 24 hours a day, seven days a week, having dedicated critical care team members that are specifically trained in neurological disorders, are all very, very important because the speed with which we treat this disease and the expertise with which we have to treat this disease is very important in this very complex disease process. UVA has all of these. UVA has one of the most experienced stroke neurology services and one of the most acclaimed neuro intensive care units in the state, if not the country. As neuro interventionalists, we have over 50 years of experience in treating all sorts of complex neurovascular diseases and a great degree of expertise in the ischemic and hemorrhagic stroke. What was the first part of the question? 

Melanie:  I just wanted you to tell the listeners how safe this procedure is and really how exciting. What’s on the horizon for this now? 

Dr. Gaughen:  What these studies have done actually is very interesting. The disease itself is a very bad disease. Stroke is the third or fourth, depending on what you read, the third or fourth leading cause of death in America and the number one cause of adult disability in the United States. The major complication with the treatment is bleeding. When we remove that clot and the blood gets back to the brain, if the brain has already been damaged, it may not be able to accommodate that blood or deal with that blood and that causes bleeding into that area. The interesting thing about this study is that in the time frames that these studies were able to get blood clot out, which is quicker than older studies, we find that that risk of bleeding is very low. In a couple of these studies, that risk of bleeding is even lower than the risk of bleeding when we give the clot buster medicine through the vein. It turns out that it is a very safe procedure compared to what we have historically seen with stroke treatment and very effective. We’re very excited about it. I think this is only going to lead to a better understanding of our ability to treat this disease in the future and I think we’re going to continue to see improved outcomes with this treatment modality. This is certainly not the end. I think it’s the beginning of a wonderful road ahead that’s going to give us a lot of information on ways to treat a disease that has been a very difficult disease to treat in the past. 

Melanie:  Thank you so much, Dr. John Gaughen, absolutely fascinating information. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.