New Stent Devices Can Limit Stroke Damage | News | Loyola Medicine
Wednesday, March 25, 2015

New stent devices can limit stroke damage, says Loyola neurosurgeon

MAYWOOD, Ill. (March 25, 2015) – Elizabeth Celli was experiencing a moderate-to-severe stroke when she arrived at Loyola University Medical Center’s Emergency Department.

Mrs. Celli was weak on her left side, had difficulty speaking and was unable to walk. Loyola’s stroke team rapidly assessed her, ordered an immediate CT scan and put her on the clot-busting drug tPA. The stroke team determined that Mrs. Celli qualified for a minimally invasive procedure to reverse the stroke.

Neurosurgeon Asterios Tsimpas, MD, used a catheter to deploy a device called a stent retriever. The device removed a blood clot that was blocking blood to a major part of her brain.

Before the procedure, Mrs. Celli had a score of 19 on the National Institutes of Health Stroke Scale. After the procedure, her scored dropped to 1, indicating almost no lasting effects. (The stroke scale ranges from 0 to 42, with scores of 16 to 20 indicating moderate-to-severe stroke.)

About 85 percent of strokes are ischemic, meaning they are caused by clots that block blood flow to the brain. The intravenous clot-busting drug tissue plasminogen activator (tPA) can restore blood flow, if it is given soon enough and the clot is small enough. But in many patients, tPA alone is not sufficient to restore blood flow. In such cases, mechanical devices deployed with catheters can be used to remove the clot.

The latest mechanical device is a stent retriever (also known as a stentriever). The device is a self-expanding mesh tube attached to a wire, which is guided through a catheter (thin tube). The surgeon inserts the catheter in an artery in the groin and guides it through various blood vessels up to the blood clot in the brain. The stentriever pushes the gelatinous blood clot against the wall of the blood vessel, immediately restoring blood flow. The stentriever then is used to grab the clot, which is pulled out when the surgeon removes the catheter. This technique, known as an endovascular treatment, is much less invasive than traditional open surgery, in which a portion of the skull is removed to gain access to the brain.

Stentrievers work faster and are more reliable than earlier generations of mechanical devices, said Loyola neurosurgeon William W. Ashley Jr., MD, PhD. “And devices are continually evolving and improving,” Dr. Ashley said.

Four recent clinical trials have demonstrated the effectiveness of the new generation of  mechanical devices. For example, results of the recent multicenter, international trial known as ESCAPE were so convincing the trial was stopped early. Stroke patients were randomly selected to receive tPA alone or tPA plus endovascular treatment with stentrievers. After 90 days, 53 percent of the endovascular group was functionally independent, compared with 29.3 percent in the group receiving tPA alone. The mortality rate was 10.4 percent in the endovascular group, compared with 19 percent in the group receiving tPA alone. The study was published in the New England Journal of Medicine.

Three other recent trials – SWIFT PRIME, EXTEND-IA and MR CLEAN – also demonstrated the effectiveness of the newer endovascular treatments. However, only a small percentage of  stroke patients experience the type of ischemic stroke examined in the trials and also arrive at the emergency department within six hours of the onset of the stroke, when endovascular treatment is most effective. 

Dr. Tsimpas and Dr. Ashley have completed advanced fellowship training in minimally invasive endovascular surgery. They are assistant professors in the departments of Neurological Surgery and Radiology of Loyola University Chicago Stritch School of Medicine.

Loyola’s multidisciplinary Stroke Center is composed of a nationally recognized team of experts in nearly every facet of stroke-related care, including emergency medicine, neurology, neurosurgery, neurospsychology, neuroradiology, rehabilitative services, social work, nutrition, pharmacy and specialty nursing.

Loyola has been accredited by the Joint Commission as an Advanced Primary Stroke Center. For six years in a row, Loyola has been recognized by the American Stroke Association with it Get with the Guidelines® - Stroke Gold Plus Quality Achievement Award for its commitment and success in implementing a higher standard of stroke care through a comprehensive system for rapid diagnosis and treatment of stroke patients.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.