Yale researchers have found ways to treat stroke patients that may otherwise be untreatable.
In a study published in the Journal of Neurosurgery, principal investigators Yale’s Charles Matouk, MD, associate professor of neurosurgery, and Nils Petersen, MD, Ph.D. associate professor of neurology, show that a method called direct carotid puncture (DCT) offers a life-saving and surprisingly safe alternative to the standard mechanical thrombectomy for patients with difficult-to-access arteries.
Americans have more than 795,000 strokes every year, leading to 140,000 deaths annually. Treatment options depend on when the stroke patient is brought to the hospital.
During the first four-and-a-half hours after a stroke starts, patients can receive tissue plasminogen activator (tPA), a protein that breaks down blood clots. But after that, it’s too late for tPA, as the risk of bleeding becomes too high. For the most severe subtype of stroke, caused by a blood clot blocking a major artery in the brain, doctors strive to combine tPA with thrombectomy, a procedure where a stent is used to remove the clot causing the stroke. Surgeons get the stent to the brain by threading a catheter through a patient’s artery, usually from the groin. While this works well in many cases, it can be a long and tricky journey.
“As we age, the blood vessels become more twisted, like the knots of a tree, and it becomes more difficult to navigate up to the head,” says Dr. Matouk. For about five to 10 percent of stroke patients, this artery anatomy problem makes mechanical thrombectomies nearly impossible.
“We know that time is brain for the patient,” says Dr. Petersen. Every minute a stroke goes untreated, 1.9 million neurons die, so immediate treatment is key to saving lives and avoiding disability.
For their study, Dr. Matouk and Dr. Petersen