Through a catheter-guided procedure, Trinity Health’s Interventional Radiology department can help lessen the damage made by strokes.
Barry Amos, DO, an interventional radiologist with Trinity Health, explained that a minority of strokes—about 15 percent—are caused by bleeding in the brain. The majority—about 85 percent—are ischemic, during which time blood clots cut off blood flow to the brain, causing brain cells to die and leading to stroke.
“About 50 percent are small blood clots,” Dr. Amos said. “They can cause significant symptoms, but they are so small the only treatment is to give a clot busting medication, TPA, through an IV if within four hours of when the symptoms started. However, about 50 percent are large blood clots,” he said. “These can cause very severe symptoms, and these are the strokes we can now treat with our interventions. With our catheter-based minimally invasive interventions, like those used to treat heart attacks, we can now effectively treat these severe strokes.”
In the past, these large blood clots, like small blood clots, were only treated with TPA, but they could only be used within four hours of when the symptoms started. Additionally, only about 10 percent of patients improve with this treatment.
With Trinity Health’s catheter-based minimally invasive intervention, also called thrombectomy, these large blood clots in the brain can be removed very quickly. Thrombectomy is effective more than 80 percent of the time at removing these large blood clots and restoring vital blood flow to the brain. Also, patients can be treated up to 24 hours after when symptoms started if there is brain tissue left to save as is with some patients.
“That’s why thrombectomy is now the standard of stroke care among many other reasons,” Dr. Amos explained. With thrombectomy, a catheter is placed in the blood vessel next to the clot and hooked to a pump which pulls the blood clot out of the vessel, restoring blood flow. “This is the new technology,” Dr. Amos said, citing clinical trials from 2015. “It saves people’s lives. It prevents them from having severe deficits (from strokes).”
Dr. Amos explained the procedure begins with an aspiration catheter, which is inserted through an artery in the groin and navigated up to the vessels in the brain under X-ray guidance. The catheter is attached to a pump, and attempts are made to pull the clot out. After two attempts, Dr. Amos said he uses a stent retriever. “They take a little more time to use and are a little more complicated to set up,” he said. “A lot of times, you don’t need to use it (first). If we can’t suck out the clot, then we’ll use the stent retriever which is effective when suction initially fails.”
Dr. Amos noted the aspiration catheter is very fast and works really well. “For me, it’s the first line of treatment.”
Additionally, to guide doctors, RAPID Artificial Intelligent software uses stroke imaging, which is then sent to a doctor’s mobile device. The doctor can immediately look at the images and determine if thrombectomy is necessary; if so, the doctor can then go to the hospital (if they are at home, for example) and take the clot out as soon as possible to save as much brain tissue as possible. This has led to significant improvements in quicker treatment times.
Stroke can also be fought by being vigilant of early signs. “I’ve treated patients 12 hours since their strokes started,” he said. “Many don’t do well because it was already too late.”
When it comes to stroke, time is brain. The longer a patient is treated for stroke, the more damage there is to brain tissue. “Every minute that goes by, you’re losing two million neurons,” he said. “Within seven or eight hours, most people will have lost so much brain tissue, you might not make a difference with treatment.”