Clotbusting devices stop strokes cold

September 18, 2012 1:33:32 PM PDT
For the past 15 years, the prime weapon for stopping strokes caused by blood clots was a chemical, tPA.

But recently, 3 new devices have arrived at area stroke centers.

And their impact has been so big, one neurosurgeon says, "The delivery of stroke treatment has exploded in the past year."

All three are for patients with ischemic strokes, in which a clot blocks a blood vessel in the brain. They are used when the standard clotbusting drug, tPA, fails to break down the blockage, or when the 3-hour time frame to use tPA has passed.

And all three of the FDA-approved devices rely on the familiar catheter technique. In these, doctors thread a small catheter, or tube, from the groin to the site of the clot.

But after that, they differ slightly.

The first device to arrive on the scene, the Merci Clot Retrieval system, uses a corkscrew-like device at the end of the catheter. it is threaded into a clot, capturing it. Then the clot and corkscrew are removed from the body along the catheter. It re-opens the blocked blood vessel.

Dr. Erol Veznedaroglu of Capital Health has used all three new devices, in trials and in practice.

He says one downside to Merci is that parts of the clot will sometimes flow downstream in the blood vessel, and that would delay complete opening of the blood vessel.

The newer Solitaire device, now in use at Jefferson University Hospital, Capital Health, and St. Mary Medical Center, uses a stent-like wire cage at the end of the catheter.

Dr. Pascal Jabbour, a Jefferson neurosurgeon, says, "The stent will open in the vessel, and you wait,to incorporate the clot inside of it, then you pull it out, and the clot will be inside of it. And you open the vessel."

Dr. Jabbour says tests showed it opened blocked brain vessels faster than the Merci device.

The newest on the market is the Trevo, made by the same company which makes the Merci device. Just days after it got FDA approval, it was used at Capital Health to stop a stroke for a 51-year-old woman.

Within 15 minutes after she was brought into the catheterization lab, the blood clot was gone, and the stroke was over.

Dr. Vez says he has used Solitaire and Trevo about 20 times each, and thinks Trevo is more flexible, and easier to handle.

But he believes both will mean a revolution in stroke treatment.

"With tPA, we had a 3-hour window after the start of a stroke to stop it," says Dr. Vez. "Now we are extending that window by 5 hours. we can use them up to 8 hours after a stroke starts."

He believes even community hospitals will adopt the use of Trevo and Solitaire soon, enabling them to save more lives, and reduce the disability from stroke.


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