Treating Stroke Patients with New Technology

The following was written by Christopher F. Dowd, MD, Clinical Professor of Radiology, Neurological Surgery, Neurology, and Anesthesia and Perioperative Care and Director of the Clinical Service for the Interventional Neuroradiology Division in the Department of Radiology and Biomedical Imaging at UCSF.

In the mid-1990s, a revolutionary drug therapy, tissue plasminogen activator or t-PA, was approved to treat strokes caused by blood clots. It was the first, and for a long time only, treatment that works by attacking and breaking up blood clots. t-PA is still used, but it certainly has its limitations – namely time. The drug must be administered within 4.5 hours of the onset of stroke, or else risks of side effects, including excessive bleeding, become too high. Additionally, t-PA is not always effective on large clots.

For these reasons, doctors from UCSF and around the world have been researching alternative methods and devices to treat stroke-causing blood clots. In 2004, I was one of the first doctors to use a new and creative clot retrieval technology. The device, a tiny corkscrew attached to the end of a guide-wire, is weaved with a catheter through the blood vessels into the brain until blood clots are reached, guiding the corkscrew into a clot. Initially designed to remove foreign items left post-surgery, we felt this technology could be improved upon.

Recently, we’ve implemented the use of a cage-like device that is inserted into the middle of the clot and expanded, causing the clot to become stuck in the cage material and allowing us to pull it out. It takes just a minute or two to tug the clot out gently and pull it onto the sheet.

Just two years ago, we used this clot removal technology on Bill Carey, a patient who came to UCSF slurring his words, the left side of his face drooping and barely able to lift his left arm or leg. Our team of specialized radiologists and neurosurgeons were able to pluck the blood clot out of his brain in surgery lasting just over half-an hour. Less than two hours later the patient awoke with no slurred words or weakness.

Of course, like with any medical procedure, it’s important to weigh the risk and benefit. It’s necessary to take into account price and other factors, including that clot retrievers, like any surgery, may cause infections, discomfort, and, very rarely, blood vessel damage or the possibility of another stroke.

We are emphasizing the need for more clinical trials to better identify the subset of patients, like Carey, who will benefit from clot retrievers. In the past, when a patient was admitted with an acute stroke you'd put them on a gurney in the back corridor because that's all you could do. Just a decade ago, these patients would have died or become permanently disabled by their stroke when the drugs didn't work. Now the treatment of stroke is similar to that of a heart attack, there are things we can do. Now it's all hands on deck for a stroke.