April 24, 2017

Clot-retrieving stents can dramatically improve stroke recovery rates, research finds—but access is limited

Daily Briefing

    Although clot-retrieving stents can dramatically increase stroke patients' chances of recovery, the treatment is not available in many parts of the United States, Michelle Cortez writes for Bloomberg Businessweek.

    Stents improve stroke care

    Currently, standard stroke care in the United States calls for using a drug called tPA to break up smaller, less accessible clots. Physicians, however, have started to push for wider use of stents after recent studies showed that stent-based clot removal offers several benefits.

    Clot-retrieving stents are inserted into a stroke patient's brain and used to capture and extract a clot to allow blood to resume freely flowing throughout the brain. The stents are priced at $8,000, which according to Bloomberg Businessweek, is "relatively cheap" for medical "hardware."

    According to a study published in the New England Journal of Medicine in 2015, 60 percent of stroke patients treated with a stent performed tasks independently after three months, compared with 35 percent of patients who were treated with drugs alone.

    In addition, research from device maker Medtronic, which manufactures a clot-retrieving stent, suggests that stents could reduce health care costs associated with stroke care. The research found that patients treated with the stents generated about $5,000 less in medical expenses over 90-days from the stent's implantation and that those patients potentially could generate about $23,203 less in medical expenses over their lifetimes.

    Many patients do not have access to stent treatment for stroke

    According to Bloomberg Businessweek, about 240,000 of the 700,000 U.S. residents who experience strokes annually have artery blockages large enough to be treated with clot-retrieving stents. However, Stacey Pugh, vice president of Medtronic's neurovascular unit, said only about 28,000 of such patients were treated with a stent in 2016.

    Access, Bloomberg Businessweek reports, likely is one contributing factor. Clot-retrieving stents are typically only available in about 150 facilities in the United States because medical centers must have an in-house neurosurgery unit, minute-saving training, and space to administer the stents.

    FDA panel recommends approval of first-ever dissolvable stent

    Another factor hindering adoption is that early versions of the stents performed poorly in major trials as recently as 2013. The studies showed the devices could result in uncontrolled brain bleeds and in some cases death. However, more recent research on newer versions has shown promising outcomes for patients treated with stents and has renewed interest in bringing stents into mainstream stroke care. 

    Experts call for increased access to stent treatment

    Recognizing patients' limited access to the stents, some physicians are calling for more facilities to be equipped to handle acute strokes and offer the stents.

    Pugh said, "A stroke patient was a stroke patient until two years ago," when "there was one thing you could do for them, and that was to give them tPA." But, she said, "The health care system is evolving," and to align with current data on stents, "it needs to evolve faster."

    Lee Schwamm, chief of stroke services at Massachusetts General Hospital and a professor of neurology at Harvard Medical School, said stents for stroke care "need to be available in the community, and access needs to be fair." She added that stents need "to be more equitably distributed," because stent availability currently is "packed in big cities, and there aren't enough in suburban communities and strategic locations in less populated areas."

    According to Bloomberg Businessweek, an additional 350 medical centers in the United States are equipped to provide the stents and currently are working to become certified as comprehensive stroke centers (Cortez, Bloomberg Businessweek, 4/6).

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