A Better Strategy for Stroke

Every year, more than 795,000 Americans suffer a stroke—with 665,000 people surviving the episode. The annual cost of stroke in the U.S. tops $33.6 billion (Circulation. 2015 ;e29-322.) and one out of six Americans will have a stroke in their lifetime. Stroke is our leading cause of disability.

About 87 percent of strokes are ischemic. IV t-PA has lead the way in treating ischemic stroke, but it fails in a quarter to a third of patients. Mechanical thrombectomy and stent retrievers are the new game-changers on the treatment scene for these patients. Plucking out the clot often removes the problems of paralysis, with patients return to normal function in minutes—even in cases where tPA has failed. As our cover story details, CT and MR perfusion imaging techniques are key to guiding swift clot identification and retrieval.

In July, the American Heart Association and American Stroke Association issued guidelines recommending a combined treatment of a stent retriever and tPA after five recent studies published in the New England Journal of Medicine found that stent retrievers reduced disability, improved neurological function, shortened recovery time and increased the rate at which stroke survivors regain function. The guidelines call for use of a stent retriever when an adult patient can be treated within six hours of the onset of stroke symptoms, has a clot in a large artery that feeds the brain and has had brain imaging that shows the brain is not already permanently damaged.

The devices are available at more than 1,000 U.S. stroke centers and hospitals. Yet at current, only about 13,000 procedures are performed annually—most often at comprehensive stroke centers. Cost is a significant factor too—with tPa-only therapy costing about $3,000 while treatment with stent retrievers jumps to about $14,000. An analysis by Lobotesis and others found medical thrombectomy saved more lives and provided survivors with a higher likelihood of independence and better outcomes. That translated into an incremental cost-effectiveness ratio of $11,650 per quality-adjusted life years gained compared with tPA alone.

It’s time to revise our predictions on stroke. We also need to encourage widespread access and reimbursement for mechanical thrombectomy and act fast in spotting stroke: face dropping, arm weakness, speech difficult and time to call 911.

Mary C. Tierney, Vice President, Chief Content Officer