Stroke Treatment Advances: Improving Recovery Outcomes

Made up of 86 billion cells connected via 1000 trillion synapses, the brain is the most complex part of the human body.

Responsible for movement, memory, speech, thinking, reasoning, vision, hunger, emotion, and more, the brain is at the core of the human experience.

If the flow of blood within the brain is interrupted, it has the potential to dramatically alter a person’s personality and limit their capabilities and quality of life.

“Which is why,” says Dr. Janhavi Modak, of the Baystate Neuroendovascular Program, “seeking help immediately whenever a stroke is suspected is imperative as is having access to the most effective and appropriate treatments.”

Calling 911 to get the stroke patient to a hospital - and get care in the ambulance along the way - is critical.

History of Stroke Treatment

For decades, researchers and physicians have known that restoring blood flow to the brain is key to preventing irreversible brain damage and even death from stroke.

Dr. Modak says, “Up until the late 1950s, the most common treatment for a stroke wasn’t much of a treatment at all. It was more a ‘hope-for-the-best approach.’ But, in 1958, a promising treatment called thrombolysis was introduced for heart attack patients, and then subsequently studied as a potential treatment option for stroke patients. It was only in 1995 that clinical trials specifically for ischemic strokes, the type of stroke experienced by 87% of people, showed success.”

Thrombolysis involves using intravenous drugs to dissolve blood clots. While far from perfect, patients who received thrombolysis were 30% more likely to have better outcomes than if they received no treatment at all.

“The best outcomes, explains Dr. Modak, “occur when the medication is administered within 3 to 4.5 hours of the onset of symptoms of a stroke. It’s also particularly effective when the clot is in a smaller blood vessel.

Advances in Stroke Interventions Improve Outcomes

“For over twenty years, thrombolysis was the best the medical community had to offer ischemic stroke patients. Many lives were saved and quality of life preserved, but the treatment really fell short of being successful for those with blockages in large vessels.”

That reality changed in 2012 when the Food and Drug Administration approved endovascular mechanical thrombectomy (EVT), also known as mechanical thrombectomy, for stroke.

“EVT has redefined the standard of care for ischemic strokes,” says Dr. Modak. “Currently, there are a limited number of medical centers, including the Baystate Neuroendovascular Program, equipped and staffed to offer it. It’s truly a game- and life-changing procedure for patients with large vessel blockages.”

EVT Treatment for Stroke

For Baystate patients, the first step of EVT treatment begins in the cardiac cath lab. Based on the CT scans, which are typically obtained in the ER, the location and size of the clot or blockage are assessed.

Dr. Modak explains, “Patients are placed on a large table and images of their brain blood vessels are obtained under X-ray guidance using contrast, and are displayed to the surgeon on a large screen. This is known as cerebral angiography, which allows for better visualization of the brain blood vessel blockage. We then insert a catheter through the wrist or groin access site and run a guide wire to navigate to the clot. Once the catheter is in place, a thin, mesh tube called a stent retriever is inserted through the catheter. When it emerges from the catheter, the retriever expands to the size of the blood vessel. The catheter and stent retriever are then retracted. As that’s done, the clot is captured by the mesh of the stent retriever and removed allowing blood to once again flow freely through the brain.” Another method to open up this blockage is by connecting the catheter to an aspiration pump, which enables the clot to be sucked out of the blood vessel, and blood flow is re-established.

Dr. Modak adds that the procedure can take anywhere from 30 minutes to two hours, depending upon how easily the clot can be accessed and how many passes of the retriever or suction aspiration are required to clear the blood vessel. The endovascular procedure can be offered up to 24 hours from stroke onset. However, like thrombolysis, she says EVT is most effective when performed within the first few hours of a stroke. “Prompt treatment is crucial for maximizing the chance of recovery and minimizing long-term disability.”

The Benefits of Stroke Treatment Options

Because no two strokes are alike, it’s important to have treatment options.

“A number of factors play a role in determining the best treatment option,” says Dr. Modak. “From the size of the blood vessel affected to any medications the patient may be taking, there are a lot of considerations. Baystate patients are fortunate in that in addition to thrombolysis, we are able to offer EVT or stroke thrombectomy as well as other advanced endovascular treatment procedures related to brain blood vessels. We’re able to quickly and accurately determine the best option and move quickly to treating patients for the best possible outcome.”

Neurological Rehabilitation Improves Function After Stroke

Baystate patients also benefit from Baystate’s neurological rehabilitation services. “The neuro-rehab team first connects with patients while they’re in the ICU. They assess what services the patient needs and create a personalized plan, including working with physical, occupational, and speech and language therapists, to help improve and regain function as soon as possible. The various forms of therapy in stroke rehab are tailored to restoring function and improving quality of life.