When a stroke hits, the go-to treatment long has been injecting a clot-busting drug. But several studies, published in prestigious medical journals over the last several months, show that mechanically removing a clot can be a more effective treatment for some types of strokes.
“These studies have really caused a sea change in how we approach certain acute stroke patients,” says Dr. Lawrence Wechsler, founder of the UPMC Stroke Institute and chair of the University of Pittsburgh Department of Neurology.
The treatment is known as endovascular thrombectomy — a physician threads a thin tube and clot-retrieving device through a person’s leg artery and up to the brain where the blockage is located. This procedure is only effective when blockages occur in large blood vessels (about 10 percent of all strokes) and needs to be performed within six hours of the onset of symptoms.
Stem-cell therapy is another promising development. UPMC has been part of a worldwide effort that has shown the safety of injecting millions of stem cells in and around the stroke-damaged areas of someone’s brain. UPMC is soon to embark on a larger clinical trial to test the procedure’s effectiveness. “With our small clinical trials that tested only for safety,” Wechsler says, “we didn’t see anybody make huge gains, but they made small gains and certainly the patients considered them to be significant… But this is probably due in large part to a placebo effect… These trial participants are going to be motivated to have some benefit occur. But what we’ve seen so far is encouraging and certainly is better than having bad outcomes.”
The larger clinical trial at UPMC will be open to those who are about a year out from a stroke and will use a line of cells derived from bone marrow. Wechsler adds, “I don’t think we expect everybody to be completely back to normal because of [stem-cell] treatment. But when you have a stroke and you can’t walk or use your arm or hand, just a small change — to be able to stand up and use a cane to get around — can have a significant impact.”