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 The conclusion is based on 500 Dutch patients treated in a landmark
study known as MR CLEAN. The findings, reported in the New England
Journal of Medicine, may encourage more hospitals to adopt the
technique.
In earlier results from the study, one third of patients whose
treatment included using a device to extract a clot from a brain
artery achieved functional independence by the 90-day mark after
their strokes compared to 19 percent given usual care.
Now, two years of data show functional independence for 37 percent
of patients with clot removal versus 24 percent with clot-busting
drugs alone.
"We are delighted. It is icing on the cake," said Dr. Reza Jahan of
the University of California at Los Angeles Stroke Center, who was
not connected with the study. "It confirms the long-term durability"
of the technique and it will encourage more centers to use it, he
said.
The MR CLEAN study, combined with subsequent positive results
released soon afterward, "has made a huge difference" in how doctors
treat strokes said study coauthor Yvo Roos, a neurologist at the
Academic Medical Center in Amsterdam. "This is now standard care,"
he told Reuters Health in a telephone interview.
Figuring out which hospitals offer the therapy can be difficult for
consumers, however. There is no easy to find list of U.S.
facilities, known as comprehensive stroke centers, that are
certified to offer the treatment whenever needed.
Jahan said the new study results reinforce efforts to evaluate
stroke patients before they even reach a hospital and then
immediately get them to one of these comprehensive stroke centers if
they are candidates for clot removal.
"It will get these patients to the treatment they need faster,
rather than the current model, where they may go to a primary stroke
center to get clot-busting drugs and valuable time is lost trying to
transport them to a comprehensive stroke center," he said by phone.
The findings apply to patients whose strokes were the result of a
blockage in the large forward arteries of the brain, which is the
most common type of stroke and affects up to 125,000 patients in the
U.S. and 90,000 in Europe each year.
Typically, the clot-busting drugs only open the blocked artery in
about a third of the cases, which is why doctors have hoped that
removing the clot directly would produce better recovery.
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Clot removal is expensive - $57,031 for the extraction and for the
first 90 days of other stroke treatment, according an analysis
published in December in the journal Stroke. Treatment without clot
extraction cost $44,752.
With the results showing a long-term benefit with extraction, "this
up-front expense is going to be justified because, in the long term,
we'll see a reduction in medical care, nursing care, home care and
rehabilitation care," Jahan predicted. "We're saving money in the
long run. Patients who would have been stuck in a skilled nursing
facility for two years, hopefully, are now being sent home."
Quality of life scores at two years were higher in the clot-removal
treatment group, with the big differences reported in the categories
of mobility, self-care and the ability to do usual activities.
The cumulative rates of death from any cause were comparable in the
two groups during the two years after a stroke, at 26 percent among
clot removal patients and 31 percent among those who didn’t get that
treatment.
But Roos and his colleagues note that the difference in mortality
rates has grown as time passed
SOURCE: http://bit.ly/2nPkmxE New England Journal of Medicine,
online April 5, 2017.
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