Study shows imaging can help stroke patients after `window of treatment`

May 29--Dorothy Berry woke up on the floor at about 4 a.m. on Feb. 17, unable to speak or move the right side of her body.

An ambulance took the 86-year-old Ashland resident to a nearby hospital, but doctors there knew that because she last appeared well when she went to bed at 10 p.m., the window of treatment likely had closed.

That's because the rule in stroke care is that physicians have about six hours to remove a blood clot in the brain. After that, it's too late.

But a clinical trial in Columbus gave Berry a second chance. Doctors flew her by helicopter to OhioHealth Riverside Methodist Hospital, where surgeons were participating in a trial testing whether imaging software could be used to determine whether blood clots should be removed in patients whose stroke symptoms started up to 24 hours earlier.

Those involved in the trial said the overwhelmingly positive results could lead to changes that would save hundreds of thousands of lives worldwide.

"It was one of the most powerful treatments that we've ever seen in any of the stroke trials that have been published," said Dr. Ronald Budzik Jr., co-director of the Riverside Comprehensive Stroke Center and primary investigator for the study at the hospital.

The images doctors took of Berry revealed a non-bleeding blood clot and showed that she was at risk of losing a great deal of her brain activity if they didn't act. Doctors removed the clot and her speech and movement returned immediately.

Researchers released results of the trial this month: 48.6 percent of patients whose clots were removed had decreased stroke disability and improved functional independence 90 days after treatment.

That compares with 13.1 percent of patients who did not have clots removed. It also showed that one of every 2.8 patients treated within 24 hours of a stroke was spared severe disability.

"It was one of the most dramatically positive stroke trials ever, as far as the actual magnitude of benefit of the treatment. It was off the charts," said Budzik said.

The study, involving non-bleeding stroke patients, was sponsored by Stryker Neurovascular, a Kalamazoo, Michigan, company that manufacturers the device used in the study to remove blood clots. The results of the trial were so dramatic that it was cut short with 206 patients enrolled, Budzik said. The initial study called for 500.

The overall study was led by researchers at the University of Pittsburgh Medical Center and Grady Memorial Hospital at Emory University in Atlanta. Riverside enrolled 14 patients.

Budzik said he expects that the new findings will be written into guidelines issued by the heart and stroke associations, leading physicians everywhere to reconsider stroke interventions.

"In our line of work, for as long as we've been treating stroke patients urgently, it's all been about time," said Dr. William Hicks II of OhioHealth Neurological Physicians. "But now, with this trial, we're able to have really good data that just came out showing that, using imaging as your guide, you can potentially impact a lot more patients."

Even before the trial, Riverside and some other hospitals had been using the imaging technology to determine treatment options, the doctors said.

However, not all neuroscientists are believers, and there is concern that the late surgeries can cause complications. But Budzik and Hicks said the trial's findings show that the practice is safe and effective, and it offers data to back up what they've been doing.

"We've been waiting for this era of stroke for years," Hicks said.

Not every stroke patient is a candidate for the expanded treatment option.

Berry was ideal because she was experiencing severe stroke symptoms, a major vessel was blocked by a clot and, while her brain had not yet been damaged, a large area was at risk.

When she came to after surgery, she recalled, Budzik asked her a question and she was able to respond. He took her right had, and she gripped his.

She's still able to quilt and crochet, work puzzles and bake cookies for her grandchildren.

"I immediately had all my faculties back. I could think. I could move," she said. "It gave me back my life back."

jviviano@dispatch.com

@JoAnneViviano

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