Neurosurgeon Says Stroke Treatment Window Deprives Patients of Life-Saving Treatment
ATLANTIC CITY, April 18, 2013 — In a presentation that challenges current thinking on emergency stroke care, a leading neurosurgeon today said the length of time between the onset of stroke symptoms and arrival at the hospital no longer should be the only criteria to determine whether to proceed with interventions.
Dr. Kenneth M. Liebman, Director of Neurosurgical Critical Care at the Capital Institute for Neurosciences, said the time criteria is outdated and deprives many patients of interventions that have been shown to both save and restore lives.
“Using time is antiquated. It does not give us valuable information, such as whether the brain beyond the blood clot is viable,” Dr. Liebman said.
His comments came during his presentation at the Capital Institute for Neurosciences 5th Annual Conference in Atlantic City.
Current guidelines say that the intravenous clot-busting medication, tPA, should be given within four and a half hours of the onset of symptoms. Endovascular interventions, such as those with mechanical retrieval devices, should be given within eight hours.
But Dr. Liebman, in his presentation, described several case studies of patients who were treated beyond the time window and who experienced profound improvement.
One case involved a 54-year-old woman with what Dr. Liebman described as a life- ending stroke who experienced facial droop and double vision and who arrived at the hospital unconscious. She was beyond the time window but Dr. Liebman proceeded with a stent retrieval device that is navigated through the groin to the patient's brain and the site of the blood clot. The device creates a channel through the clot, restoring blood flow, and then the clot is removed.
He showed video of the patient fully mobile and well after the procedure.
He described several other cases, including a 62-year-old man who could not move one side of his body. Hours after the intervention, given beyond the window, the patient was able to move all his arms and speak fluently.
“I feel certain these endovascular treatments greatly helped these patients,” Dr. Liebman said. “We must re-think this criteria so more people will benefit from the emergency stroke treatments we have today.”
Dr. Liebman disputes that time alone can determine if the injury to the brain can be reversed.
Instead of relying on the clock, Dr. Liebman said a diagnostic test, CT Perfusion, can be used to determine if brain tissue is viable and the patient would benefit from treatment to remove the clot and restore blood flow.
Dr. Erol Veznedaroglu, director of the Capital Institute for Neurosciences, said the guidelines are based on outdated data and are “negligent. We are withholding life-saving therapy to patients and people are dying.”
Dr. Liebman also described the newest treatments now being used to treat arteriovenous malformations, or AVMs, and aneurysms. He said multiple interventions now exist, and so patients with brain emergencies should be treated by physicians with access to the full armamentariam of treatments.
“You want to be treated using the intervention that is best for the patient and not best for the doctor or hospital,” he said.