New advance in stroke treatment will benefit more Wyoming patients
By Kristy Bleizeffer May 30, 2017
The past five years have brought unprecedented advances in the treatment of stroke, including a major announcement two weeks ago that will improve care of Wyoming patients.
At the European Stroke Organization Conference in Prague, scientists presented results from the DAWN stroke trial that some patients can respond to stroke treatment up to 24 hours after the start of stroke symptoms.
“Practically speaking, what this means is that if you have a stroke that is caused by the occlusion of a big blood vessel in your brain, it’s been within 24 hours and you get to a stroke center … we may be able to go in with our catheter-based treatments, pull that clot out and reverse the effects of the stroke,” said David Wheeler, M.D., Ph.D., a neurologist and medical director of Wyoming Medical Center’s Primary Stroke Center.
There are basically two ways to treat an ischemic stroke —the kind in which a clot blocks blood flow in arteries leading to or in the brain:
- Administering clot-busting medication called tPA (tissue plasminogen activator) via an IV
- Mechanically removing the clot with a specialized stent and image-guided technology, or mechanical thrombectomy, performed by the Interventional Radiology team.
Previously, guidelines recommended treatment begin up to 4 ½ hours after start of stroke symptoms for IV tPA, and up to 6 hours for mechanical thrombectomy. Outside that window, a patient’s chances of recovering from a stroke were believed to drop significantly.
The DAWN trial stretched the window of time for mechanical clot removal from 6 hours to 24 hours in certain cases.
“It’s important to note that this large international trial was stopped early because the results were so overwhelmingly positive. Statistically, it’s a very strong result,” Wheeler said.
The intention of the DAWN trial was to determine whether people who woke up with stroke symptoms could respond favorably to stroke treatment if advanced imaging studies showed there was still brain left to save within the area of stroke. Historically, there was no way to determine when a stroke had started in a sleeping patient, and so no way to determine whether they fell within the treatment window guidelines. The study found that 48.6 percent of patients who underwent mechanical thrombectomy within 24 hours of onset of symptoms had a good outcome after 90 days.
This will have real effects for Wyoming patients, Wheeler said.
“WMC will work quickly to make this the standard of care for such stroke cases, but that means a sizeable commitment in time and resources to devote to such cases 24 hours a day. Interventional radiology now participates in treatment in about 1 in 5 stroke patients now, mechanically removing clots from blocked vessels,” Wheeler said.
That number will most certainly increase as more stroke patients prove to meet the new criteria for mechanical removal.
Wyoming Medical Center is better equipped to save brain function than anywhere else in the state. Our Primary Stroke Center is Wyoming’s first center certified by the Joint Commission, and we have been honored by the American Stroke Association as among the best stroke centers in the country. Our stroke team is made up of members from nearly every department in the hospital including EMS, ER nurses and physicians, radiology, laboratory, pharmacy, ICU, neurology, therapies, case managers and more. The team meets monthly to analyze the latest data, collaborate on best care practices and troubleshoot areas that need improvement.
“When someone comes to our ER having a stroke, we on average get them treated within 30 minutes of arrival. This is really as good as stroke care as you’ll find in any hospital in the country,” Wheeler said.
Our stroke team is now working with hospitals and ERs across the state to help them deliver the same high level of stroke care to everyone in Wyoming. Building systems around these new guidelines will help save even more Wyoming lives.
“I’m very proud of the stroke program at Wyoming Medical Center. It’s a tremendous example of what a team of very dedicated and very passionate healthcare workers can do when they come together to serve a community like Casper,” Wheeler said. “And, we are very dedicated to bringing this level of service to the people throughout the state of Wyoming.”
Dr. Wheeler is a neurologist at Wyoming Neurologic Associates.