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Neurosurgeon Says Change in Stroke Treatment Criteria Needed to Save Lives
In a presentation that challenges current thinking on emergency stroke care, a leading neurosurgeon said the length of time between the onset of stroke symptoms and arrival at the hospital should no longer be the only criteria used to determine whether to proceed with endovascular interventions.
Dr. Kenneth M. Liebman, Director of Neurosurgical Critical Care at the Capital Institute for Neurosciences, said the time criteria is outdated and deprives many patients of interventions that have been shown to both save and restore lives.
“Using time is antiquated. It does not give us valuable information, such as whether the brain beyond the blood clot is viable,” Dr. Liebman said.
His comments came during his presentation at the Capital Institute for Neurosciences’ 5th Annual Conference in Atlantic City.
Current guidelines say endovascular interventions, such as those with mechanical retrieval devices or stents, should be performed only within eight hours of onset.
However, Dr. Liebman described several case studies of patients who were treated with interventions to open the clot and restore blood flow to the brain that took place beyond the currently stipulated time window. These patients experienced profound improvement.
One case involved a 54-year-old woman with what Dr. Liebman described as a life-ending stroke who experienced facial droop, double vision and arrived at the hospital unconscious. She was beyond the time window, but Dr. Liebman proceeded with a stent retrieval device that is navigated in a minimally invasive fashion within the patient’s body from the groin to the location of the blood clot in the brain. The device creates a channel through the clot, which immediately restores blood flow. The clot can then subsequently be removed.
He showed video of the patient fully mobile and well after the procedure.
He described several other cases, including a 62-year-old man who could not move one side of his body. Hours after the intervention, again given beyond the time window, the patient was able to move both of his arms and speak fluently.
“I feel certain these endovascular treatments greatly helped these patients,” Dr. Liebman said. “We must re-think this criteria so more people will benefit from the emergency stroke treatments we have available to us today.”
Dr. Liebman disputes that time alone can determine if the injury to the brain can be reversed.
Instead of relying solely on the clock, Dr. Liebman informed the audience that a diagnostic test, CT Perfusion, can be used to quickly determine if the patient’s brain tissue is viable and would benefit from treatment to remove the clot and restore blood flow.
Dr. Erol Veznedaroglu , director of the Capital Institute for Neurosciences, said the guidelines are based on outdated data and are “negligent. We are withholding life-saving therapy to patients, and people are dying.”