Treating acute strokes mechanically


When a  patient unexpectedly suffered a stroke while waiting for another procedure, Macquarie University Hospital rapidly assembled an expert team to perform a successful mechanical stent thrombectomy - increasingly recognised as a superior procedure for certain acute stroke patients.

In January this year, patient Van Nguyen, while waiting to have an elective coronary angiogram found himself unexpectedly undergoing a different procedure after suffering an acute stroke in the waiting area of the hospital's Angiography suite.

Mr Nguyen's sudden inability to talk and loss of movement with severe weakness on one side of his body alerted staff, and a code blue was called.

Imaging, which was immediately arranged through Macquarie Medical Imaging, demonstrated occlusion of the middle cerebral artery. Mr Nguyen deteriorated further and was returned to the Angiography lab for an emergency acute mechanical stent thrombectomy, performed by Interventional Neuroradiologist Dr Brendan Steinfort,

There are 50,000 acute strokes in Australia each year,” explained Dr Steinfort, a pioneer in acute stroke treatment with advanced expertise in carotid stenting, cerebral aneurysm treatment and intracranial hypertension.

"Standard treatment includes intravenous thrombolysis using recombinant tissue plasminogen activator to break down blood clots.

"However, approximately 10 percent of acute stroke patients would potentially benefit from mechanical thrombectomy ­a new treatment that uses 'stent-retriever' devices to remove the thrombosis.

''Although fully approved for use in Australia, in New South Wales, only about 400 of a potential 2000 patients who may benefit from this procedure receive it. This is due to factors such as delayed presentation, lack of clinician awareness and difficulty accessing resources in a timely fashion," he said.

The team treating Mr Nguyen was rapidly assembled.

Admitting physician and cardiologist Dr Ru-Dee Ting, neurologist Professor Dom Rowe, anaesthetics, cath lab staff and the ICU all worked alongside Dr Steinfort to provide the best possible outcome. The complex procedure required multiple thrombectomy runs and Reopro bolus infusion.

The patient was transferred to ICU following the procedure. He improved overnight and was discharged three days later with no neurological deficit from the stroke.

Dr Steinfortwas the first person in Australia and probably the second in the world to perform a mechanical stent thrombectomy for acute stroke. Working collaboratively with Dr Kenneth Faulder and Dr Timothy Harrington, Dr Steinfort has participated in extensive research, including one of the first case series of mechanical stent thrombectomy. This INR team was the only Australian unit in the Solitaire Thrombectomy for Acute Revascularisation (STAR) trial and the only Sydney unit to participate in the seminal EXTEND-IA, trial.

Written by Andrea Lewis and photography by Tim Robinson.


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