Neurosurgeon
Demetrius Lopes holds up a Penumbra stroke vacuum system, the newest
treatment for stroke victims, which promises to literally suck out
clogged arteries in the brain to get blood flowing
It’s a tiny vacuum cleaner for the brain: A new treatment for stroke
victims promises to suction out clogged arteries in hopes of stopping
the brain attack before it does permanent harm.
Called
Penumbra, the newly approved device is the latest in a series of
inside-the-artery attempts to boost recovery from stroke.
Now
the question is how to determine which patients are good candidates
- because, illogical as it may sound, unclogging isn’t always the best
option.
“Is the patient at a stage of stroke where you’re going
to hurt them by pulling a clot out, or show benefit?” asks Dr Walter
Koroshetz of US’ National Institutes of Health (NIH). “It’s good we
have devices. Now we have to learn how to use them.”
Millions around the world suffer a stroke each year, sometimes fatally.
Survivors often face serious disability.
Most
strokes occur when blood vessels feeding the brain become blocked,
starving delicate brain cells of oxygen until they die. For those, the
clot-busting drug TPA can mean the difference between permanent brain
injury or recovery – but only if patients receive intravenous TPA
within three hours of the first symptoms.
Yet fewer than 5 per
cent of stroke sufferers get TPA, because they don’t get specialised
care in time. And of those treated, it only helps about 30 per cent,
because the clot is often too big or tough for TPA to bust.
Enter
Penumbra, an option for patients who miss out on early care – it can be
tried up to eight hours after a stroke strikes – or if standard TPA
treatment fails.
Specialists thread a tiny tube
inside a
blood vessel at the groin and push it up the body and into the brain
until it reaches the clog.. Just like a vacuum cleaner, it sucks up the
clot bit by bit to restore blood flow.
For the right patient,
Penumbra can produce dramatic help, says Dr Demetrius Lopes of
Chicago’s Rush University Medical Centre, one of two dozen hospitals
that tested the device in 125 severe stroke patients.
He points
to 45-year-old Aretha Streeter, whose left side remained paralysed
almost an hour after a big dose of TPA. Lopes scanned her brain and
spotted a key artery completely blocked. She agreed to the Penumbra
experiment, and started moving as the clot was suctioned out. Streeter
was walking the next day, and was left with weakness in her arm instead
of paralysis.
The full results will be presented next month at a meeting of the American
Stroke Association.
But here’s the catch…
Unclogging
sometimes does more harm than good in bad strokes, says Koroshetz,
deputy director of NIH’s National Institute for Neurological Disorders
and Stroke.
When the dam is broken and blood rushes into oxygen-deprived brain tissue, it
sometimes triggers swelling or a brain hemorrhage.
Either can kill.
So
treatment is a balancing act: Using brain scans to estimate if the
stroke already has killed all the brain tissue it’s going to, or if
enough still could be salvaged that it’s worth the risk of this injury,
Koroshetz explains.
“Your ability to succeed with taking the clot out depends on what’s going on in
the brain,” he cautions.
For
patients, the message is clear: Call hospital emergency as soon as you
experience stroke symptoms. They include sudden numbness or weakness,
especially on one side; confusion, trouble speaking or walking; or an
abrupt terrible headache.
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