UB neurosurgeons report new standard for stroke care

The standard of care for stroke patients is about to undergo a revolution, and UB neurosurgeons are at its forefront.

That was the message UB neurosurgeons working at Gates Vascular Institute delivered at a Tuesday morning press conference.

L. Nelson Hopkins, SUNY Distinguished Professor of Neurosurgery and former chair of the Department of Neurosurgery, called it the most dramatic change he has ever seen in medicine.

They were discussing SWIFT PRIME, a major international clinical trial led in the U.S. by Elad Levy, professor and chair of the Department of Neurosurgery and medical director for neuroendovascular services at Gates, and Jeffrey Saver, professor of neurology at UCLA. Saver reported the results at the International Stroke Conference last week.

Ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases.

The SWIFT PRIME trial was conducted at 36 sites worldwide to determine if patients who experienced an ischemic stroke experienced better outcomes with the intravenous clot-busting drug t-PA alone versus t-PA in conjunction with the use of a wire mesh stent device called Solitaire, made by Covidien. The trial examined the use of the Solitaire™ FR (Flow Restoration) Revascularization Device within six hours of symptom onset.

Solitaire is a wire-mesh stent device that is inserted through a tiny incision in the groin and threaded through the femoral artery by catheter to the vessel in the brain that’s blocked. When the mesh device is opened, it captures the clot and pulls it out as the catheter is removed. Normal flow to the brain is restored and damage to the brain due to lack of blood is mitigated. For the clinical trial, t-PA was administered to the patient prior to the Solitaire procedure.

“The findings were definitive,” said Adnan Siddiqui, professor and vice chair of neurosurgery and site principal investigator for the trial at Gates Vascular Institute, one of the trial’s top three enrollment sites. “When Solitaire is used along with t-PA, patients have the best chance for survival and return to normal function.”

Levy said some patients who were treated with t-PA plus the wire-mesh stent were able to leave the hospital after just a few days, in stark contrast to what has been standard of care, where patients spend several days in the intensive care unit then additional time at a rehabilitation facility.

“It restores blood flow to the brain far faster and provides the patient the absolute best chance for a positive outcome,” he said. “In many cases, there’s no need for the ICU and no need for rehabilitation. This is a game-changer.”

Part of the team’s success has to do with highly streamlined workflow procedures that have been instituted at Gates, Levy said. For example, when Emergency Medical Services responds to a suspected stroke call, they activate the Stroke Team right from the field so the team is waiting in the Emergency Department when the patient arrives. The team performs a CT perfusion study, which allows them to visualize where the clot is located and what portion of the brain is not receiving blood.

“Once we review the scan results, the patient is in a procedure lab within an hour. This is remarkably fast and is a direct result of the work-flow efficiency here at the Gates Vascular Institute,” said Kenneth Snyder, assistant professor of neurosurgery.

Robert N. Sawyer Jr., clinical associate professor in the UB Department of Neurology and chief of stroke services for Kaleida Health, said participation in such landmark trials benefits the community in a major way. “By participating in such trials, we can provide patients with cutting-edge treatments,” he said.