New Ways to Treat Patients with Large Vessel Occlusions
In This Video
- Thabele M. Leslie-Mazwi, MD, is a specialist in Neuroendovascular and Neurocritical Care at Massachusetts General Hospital
- His research focuses on developing treatments for a subset of ischemic stroke called large vessel occlusion stroke
- Here, he discusses the success of the DEFUSE 3 trial, the use of CTA at referring hospitals to help triage patients who need thrombectomy to specialty centers, and expanding the inclusion of patients that are eligible for thrombectomy
Thabele M. Leslie-Mazwi, MD, is a specialist in Neuroendovascular and Neurocritical Care at Massachusetts General Hospital. His research focuses on developing treatments for a subset of ischemic stroke called large vessel occlusion stroke. In this video, he discusses the success of the DEFUSE 3 trial, the use of CTA at referring hospitals to help triage patients who need thrombectomy to specialty centers, and expanding the inclusion of patients that are eligible for thrombectomy.
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Transcript
We have focused particularly on the developments and the treatment of ischemic stroke, and a particular subset of ischemic stroke called large vessel occlusion stroke. To provide some perspective, large vessel occlusion stroke accounts for about 20% of total stroke volumes.
But if you look at the disability and the mortality from stroke, large vessel occlusion accounts for about 60% of the severe disability, and an astonishing 90% of the mortality. And so, anything that we can do to that subset of patients, even though they're a small subset within the general population of stroke, will have a disproportionate impact on the burden of this disease in our communities.
Our involvement was in a particular trial called DEFUSE 3, and this was a trial that looked at the benefit of stroke therapy, in this late window of patients that have woken up with symptoms, or come in after six hours from onset. In fact, we were one of the top enrolling sites for the trial, and the trial was resoundingly positive, and has been one of the trials that has affected such a change in the care of these patients in general.
The first fundamental step is to be able to identify who has a large vessel occlusion. In the pre-hospital environment, with the EMS crews, that means that the EMS team has to be able, on the scene, detect that this patient might suffer from such an event.
And we've been working with our statewide EMS to train the crews, using a particular algorithm called FAST ED, that was actually developed by some of the team at Massachusetts General Hospital. At the level of the referring hospital, we're aiming to disseminate the use of CTA across the state, and in fact, in this effort, we're a pioneer in the United States.
Up to this point, referring hospitals were discouraged from performing vessel imaging because the idea was that, for candidates, that imaging would be done at the receiving hospital where thrombectomy would occur. Now we want to spread the triage of patients back out to the referring hospital level, and that way, only patients that need to be transferred for thrombectomy do get transferred. And patients that can stay in their local care environment and receive excellent care there can stay.
Finally, at the level of the receiving centers, the centers that can perform thrombectomies, our goal is to ensure is that there's some standardization of selection process and technique, and that we have a unified approach to quality metrics and patient outcomes.
So, in the middle of this exciting time, as we undertake these sort of changes, there are some horizons that we are looking out to. One of the big ones is going to be to expand the inclusion of patients that are eligible for thrombectomy.
We think this will expand to patients that already have relatively large established strokes, that are currently excluded from many selection paradigms, and we think will expand to patients that, even though they have an occluded vessel in the intracranial circulation, have a good neurologic exam, because those patients often can fail late.
We're actively involved in the formulation of and the implementation of trials to answer those very questions.
The second question that we think is going to be an impressive and important change will be changes to the use of thrombolytic therapy, and the new thrombolytic agents that are challenging the dominance of alteplase, in the treatment of acute stroke. And we're very excited about bringing that to our patients here in Massachusetts and to the region.
Learn about the Cerebrovascular Program at Mass General
Learn about stroke care at Mass General