Brain stents show major promise for some stroke patients

Stroke experts are reporting a major advance: Stents similar to the ones used to open clogged heart arteries also can be used to clear a blood clot in the brain, greatly lowering the risk a patient will end up disabled.

Patients treated with these brain stents were far more likely to be alive and able to live independently three months after their stroke, doctors said Wednesday at an American Stroke Association conference in Nashville.

The treatment was so successful that three studies testing it were stopped early, so it could be offered to more patients. One study also found survival was nearly twice as high for those given the treatment.

"This is a once-in-a-generation advance in stroke care," said the head of one study, Jeffrey Saver, stroke chief at the University of California, Los Angeles.

The trial led by Canadian researchers included patients from Abington Memorial and Temple University Hospitals.

An independent expert, Lee Schwamm of Massachusetts General Hospital, called it "a real turning point in the field." For many patients, "this is the difference between returning home and not returning home," he said, although not all patients qualify.

Hana Choe, assistant director of neurointerventional care at Abington Health, said her center was now routinely using the study protocol in patients with appropriate blockages. "It's really going to change the way we practice in neurointervention," she said.

Guillermo Linares, director of neurointerventional services at Temple, said the trial was testing more than just a new device. It required faster diagnosis, faster activation of the stroke team, and faster technology. All contributed to what he called a "landmark moment."

Most of the 800,000 strokes in the United States each year are caused by blood clots in the brain. The usual treatment is clot-dissolving medicine called tPA. When that doesn't work, doctors sometimes try devices pushed through blood vessels to pluck out the clot, but several studies found they did not help.

However, newer devices - metal mesh cages called stent retrievers - open an artery much faster and with less blood-vessel damage. Unlike heart stents, which stay in place to prop the artery open, the brain stents flatten the clot, trap it, and are removed with the clot.

To be effective, tPA must be given within 4.5 hours after stroke symptoms begin, Choe said. Researchers are still discovering the outer limits for the retrieval devices, she said, but the trial included patients who had symptoms for up to 12 hours.

Two brands are sold in this country - Trevo, made by Stryker Corp. of Kalamazoo, Mich., and Solitaire, made by Covidien, now part of Minneapolis-based Medtronic Inc. They won approval in 2012 based on their ability to remove a clot - not because there was evidence they made patients better.

Some people who got them had dramatic results. Don Sadoway, 64, a chemistry professor at Massachusetts Institute of Technology, was having a holiday lunch on Dec. 23, 2012, at a Boston restaurant when he suddenly found he couldn't lift his wine glass for a toast. His wife was perplexed.

"I said something unintelligible to her and all of a sudden my right side collapsed," he said.

Doctors at Massachusetts General gave him tPA, but it did not work, so they tried a Solitaire stent.

"Two hours later I was sitting up, talking to my kids," said Sadoway, who is fine now except for small problems with memory and fine motor skills.

Last fall, a study in the Netherlands that tested a variety of clot removers, mostly stents, found these treatments greatly lowered the risk of disability in patients whose clots were not dissolved by tPA.

Stroke experts said more studies were needed to confirm the success. The three new studies do that; all were stopped early because independent monitors saw better results three months later in those treated with devices.

A study that UCLA's Saver led in the U.S. and Europe on 196 patients found 60 percent of those treated with a Solitaire stent were free of major disability vs. 35 percent of those given just tPA.

A study led by Australian researchers of 70 patients found 71 percent of those given a Solitaire stent were free of major disability vs. 40 percent of those given tPA alone.

A study led by Canadian doctors of 316 patients found 53 percent treated with a stent or other clot-removing devices were free of major disability vs. 29 percent of those given just tPA.