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New technique revolutionises treatment for stroke

New technique revolutionises treatment for stroke

A revolutionary treatment for stroke that involves removing the clot using a tiny device inserted into an artery results in more people able to go home independent, and has no higher rate of injury or death than conventional treatments.

The technique, called clot retrieval, “is probably the most significant advance in stroke care in the last 20 years. It will lead to a revolution in care,” says Professor Alan Barber. He will present the findings of a study into clot retrieval today at the annual scientific meeting of the Australian and New Zealand College of Anaesthetists in Auckland.

“Stroke – when a blood clot blocks an artery to the brain – is the major cause of long-term adult disability, and the second cause of death after heart disease,” he says. “It costs Australia billions. But for every five people you treat with clot retrieval, one more will go home able to function as an independent person, and there is one less person who is left severely dependent.”

Professor Barber was one of the investigators in the Extend-IA study, which examined how 1287 patients with severe strokes across Australia and New Zealand responded to two different courses of treatment. The first group received only traditional clot-dissolving drugs, which fail to clear two-thirds of massive clots.

The second group received the clot-dissolvers first, and if those drugs failed, were then given clot-retrieval surgery. This involves inserting a catheter or tube into an artery; squirting dye along it so that the blockage can be X-rayed; and then inserting a tiny, folded-up wire cage into the catheter.

This wire is fed up to the point of the blockage, where it is opened, encases the clot and then used to pull the clot out.

While the technique sounds simple, it requires a high-level team of medical experts including neurologists, anaesthetists, radiologists, intensive-care and stroke specialists.

“It’s not the sort of thing you can do in a suburban hospital,” Professor Barber says. “What we need to do next in Australia and New Zealand is set up a series of clot-retrieval centres in tertiary hospitals.”

Other presentations at the conference today will say:

• A range of simple changes in the care of mothers who require planned caesarean sections helps them to be up and active sooner, to be ready for discharge from hospital a day earlier, and to have more opportunity to establish breastfeeding. The changes include having a carbohydrate drink before surgery, better pre-operative information and earlier removal of medical devices such as catheters, according to Dr Matthew Drake, a specialist obstetric anaesthetist at National Women’s Health, Auckland City Hospital.

• It is costing more for hospitals across New Zealand and Australia to care for obese pregnant women giving birth by caesarean section, as these patients take up to 18 minutes longer in anaesthesia time, an increase of up to 25 per cent. This amounts to extra costs of $25 per minute for hospitals, according to Professor David Story, Chair of Anaesthesia at the University of Melbourne and lead investigator of the MUM SIZE study of 1500 women.


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