blood clot in an ischaemic stroke
Posted in Best practices/emergency care For the general public

Clot removal effective even after six hours

It is good news; until 2018, we knew that neurosurgeons can salvage living neurons only if they remove the clot within six hours of the block. Now, we know it is not so. They can go ahead with the operation if a patient is ready for the surgery even after six hours.

About the study

This finding was published in the The New England of Journal of Medicine in 2018. An eminent group of US researchers conducted this study recruiting stroke patients from 32 stroke centres; so, it was a multi-centre study. They compared recovery levels of two groups of stroke patients after three months; one group received only the clot-buster drug and the other group underwent the clot-removal operation. They prematurely terminated the study after evaluating the results of 182 patients – the result was so obvious – after three months, 45 per cent of people became functionally independent as against 17 per cent of those who received only the clot-buster drug.

This study was about ischaemic stroke. In an ischaemic stroke, brain cells die as a result of a block to blood flow by a blood clot. More than two-thirds of strokes occurs due to a blood clot. There are other types of stroke too. Read about stroke types through this link.

Clot removal surgery (Thrombectomy)

The following caption was published in the NIH Director’s blog. As we all can see, a tiny tube is sent to the blocked area to retrieve the clot.


Caption: Schematic of how the clot retriever used in the reported trials is opened inside a blood vessel to surround a clot that is blocking blood flow. Once caught by the stent, the entire apparatus with the clot is removed from the body out a small puncture in the femoral artery at the groin.
Credit: Covidien

This is not a reason to delay in seeking medical attention!

However, this does not mean that anyone suspected of having a stroke can afford to delay seeking hospital care; we should ideally receive specialised care within the first hour of a suspected stroke – even earlier the better. One with a confirmed diagnosis should receive the clot-buster drug within the first hour from the “last known normal”. you can read about it more through this link.

The New York Times provided wide publicity to this remarkable discovery in their January 24th publication in 2018.

A banner to promote use of (tPA) tissue plasminogen activator
Posted in Best practices/emergency care For the general public

Do you know about the clot-busting drug?

Yes, whenever a person suspected of having a stroke reaches a hospital with stroke care facilities within four and a half hours of the event – that is from the last known normal – he or she should have the clot-busting drug. This is the 2018 recommendation by the American Heart Association/American Stroke Association.

What is this clot-busting drug?

This drug is called “tissue plasminogen activator” (tpa); however, there is a catch: its benefits are time-dependent; earlier the better. Ideally, it should be within the four and a half hours from the “last known normal“. Before administering this medication, they recommend someone to have two tests: a non-contrast CT scan and a random blood glucose test. The CT scan is necessary to determine whether the attack is either due to a blockage to the supply route or due to bleeding. If it is due to bleeding, this drug is not recommended.

This finding was first discovered 24 years before and The New England Journal of Medicine journal published the study in 1995. However, even after this prestigious college’s endorsement, some emergency physicians seem to be reluctant moving forward with the practice. Recently, Gina Kolata elaborated experts’ arguments for and against this practice in an article written to The New York Times.