Stroke Treatment - Mechanical Thrombectomy

Ajit S. Puri, MD DM Associate Professor Radiology University of Massachusetts Medical SchoolDr. Ajit Puri, Division Chief for Interventional Neuroradiology recently received an educational grant to make a video on stroke treatment using mechanical thrombectomy, an endovascular procedure that is performed in neurointerventional radiology. For most stroke patients with an occlusion in the larger arteries of the brain, mechanical thrombectomy has become the gold standard for treatment in combination with tPA administration, where indicated. In fact, results of recent clinical trials have resulted in the AHA revising their guidelines for stroke therapy[1]. However, it is estimated that while a patient is experiencing a stroke, 1.9 million neurons, 14 billion synapses, and 714 km of myelineated fibers are lost each minute; therefore, time is of the essence[2]. One of the primary goals of this grant was to capture actual patient stories as a means to illustrate both the remarkable patient outcomes after mechanical thrombectomy and the importance of getting patients into the angiosuite as soon as possible. Multiple teams are involved in this effort beginning with first responders, the emergency room staff, stroke team, and anesthesia team as well as the NIR team, so it is important to get everyone on the same page to develop strategies to improve the time from stroke onset to clot retrieval.  These patient stories were so compelling that Dr. Puri and his team ended up with enough footage for two educational videos. Future research in this area is focused on improving the design of the devices, optimizing imaging techniques for patient selection, and refining neurointerventional techniques for performing this procedure.
Special thanks go to the patients and their families for sharing their stories, to the NIR team (Dr. Ajay Wakhloo, Dr. Francesco Massari, Dr. David Rex, Dr. Lozano, Dr. Demacedo-Rodrigues, Mary Howk, Jenna L’Heureux, Christopher Brooks, and Kimberly Ty) and also to Dr. Matthew Gounis and his team in the NECStR lab for their support in creating these videos.
 
1.   Powers, W.J., et al., 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 2015. 46(10): p. 3020-3035.

2.    Saver, J.L., Time Is Brain—Quantified. Stroke, 2006. 37(1): p. 263-266.

Stroke Treatment Using Mechanical Thrombectomy from UMass Medical Radiology Dept on Vimeo.

Stroke Treatment - UMass Memorial Medical Center - Interventional Neuroradiology from UMass Medical Radiology Dept on Vimeo.