“Lazarus-effect on the SURGERY table: a New stroke therapy brings breakthrough
A revolutionary new method of treatment is effective for severe stroke immediately. Consequences such as paralysis and speech disorders disappear. However, tele-medicine and mobile teams of specialists, such as the Flying Doctors have improved the prognosis of stroke. However, the area-wide supply is in danger. FOCUS Online spoke with an expert.
In the majority of cases an acute Vascular occlusion in the brain is the cause for a stroke. Until recently, the only way through blood thinning the clot to dissolve and make the passage free again. It is administered as an Infusion of the drug Alteplase (rt-PA). This systemic thrombolytic therapy, abbreviated to lysis, for about 20 years.
Effective in moderate to severe stroke was until a few years ago, impossible
However, at about ten percent of the approximately 270,000 for stroke patients in Germany, this therapy is not enough. This is the case when a heavier stroke is present, that is, when one of the six major blood vessels in the brain affected.
Probably almost everyone knows of us, one of these stroke patients. Consequences such as paralysis, disorders of language, Swallowing, Hearing, and the sense of balance does not stay with them often for ever, some patients survive severe stroke.
Breakthrough in stroke therapy
“This has improved with a new, revolutionary treatment option,” says Helmuth Steinmetz, Director of the centre for neurology and neurosurgery at the University hospital of Frankfurt and member of the management Board of the German stroke society.
The talk is of a mechanical Removal of the Thrombus. A special catheter, the stopper is simply pulled from the vessel. The technical term for this treatment is Thrombectomy. Their effectiveness is proved since 2015. “As the heart attack is introduced via the groin artery with a catheter into the skull to the Vascular occlusion,” explains the Professor. The Thrombus is then recovered with special tools and a hollow catheter is suctioned.
Thrombectomy is 90 percent successful
The success of the treatment occurs, so to speak, immediately, experts speak in this context of a “Lazarus effect”. Over 90 percent of the vessels can be opened with Thrombectomy. The procedure has already been performed more than 10,000 times in Germany in certified centers with specialized Neuro-radiologist.
Time is Brain – different time Windows of the two therapies
However, no matter how effective the new therapy is also bound to a time window, such as any treatment of a stroke. Because “Time is Brain” – time is not money, but the brain: to Be cut off by the vascular closure, the parts of the brain for too long of the blood supply, the risk is that you die permanently. So, there is a time for the Thrombolysis window of up to four and a half hours. “In the Thrombectomy 24 hours as the upper limit,” says neurologist Helmuth Steinmetz.
Telemedicine supports area-wide supply
The acute therapy for stroke is carried out mainly by 322 certified Stroke Units, so the treatment units in hospitals that have the necessary techniques and specialists. Stroke Units should guarantee the timely and qualified treatment.
However, only about half of the Stroke can perform Units the Thrombectomy as a new method of treatment. The supply is still not universal.
Thus, patients can benefit best in the whole of Germany of targeted treatment for a stroke, and, therefore, different projects. One of them, for example, the tele-consultation. A Patient with suspected stroke in a hospital is admitted, are immediately created Computer – or magnetic resonance cat scans of his brain. By video transfer, the Doctors can now discuss with experts in specialized tele-neurology centers of the therapy. In some cases, the Patient to this therapy needs to be moved to another, larger center.
Flying Doctors, the special mobile unit
Another model project is running with the “Flying Doctors” is currently in Bavaria. Under the abbreviation "FIT Flying Interventionalisten" access to specialist neuro-radiologists who can perform a Thrombectomy, quickly to the patient.
“Which method is better for the success of the treatment – the specialists come to the patient, or the Patient is transferred to a specialized treatment in a larger center – you only can tell after some time,” the expert in the denominator.
Germany in stroke therapy Note 1, at aftercare Note 3
But one thing is sure already: The treatment for stroke is as good as never before, “in the international comparison, Germany occupies a top place,” says Helmuth Steinmetz. However, there are still deficits in the post-treatment, i.e. when the Patient may live with limitations, and home again independently.
The doctor then didn’t often have the time to operate this elaborate aftercare carefully and to keep the risk of a further stroke as low as possible.
Targeted aftercare can help to avoid second stroke
This prevention would be particularly important because, in many cases, the second stroke more dramatic consequences than the first, a study reaffirms. More than half of the patients must be expected with a permanent disability and approximately 20 percent die. Follow-up care, treatment, and close monitoring of blood pressure, blood values, as well as a healthy life style can be that is why after a stroke is vital.
Specialists for follow-up care: SANO and STROKE OWL
Therefore, further projects were launched, such as STROKE OWL, the so-called “stroke pilot”, an Initiative of the German stroke Foundation. For the time being, the project in East Westphalia-Lippe (“OWL is intended to serve”) up to 2,000 stroke patients through professional stroke-pilot. You advise the person and their family, to function as a connection to health insurance companies and Doctors, all with the aim of improving the quality of life of patients, reduce complications and risk factors.
At the beginning of 2019 SANO to start, developed by Professor Armin gray, Klinikum Ludwigshafen, Germany, Neurological clinic. This is a professional interdisciplinary network of stroke coordinator, in-house doctor and a Stroke Nurse, a trained Stroke nurse. SANO will initially run in 15 regions in Baden-Württemberg, Bavaria, Hesse, North Rhine-Westphalia, Rhineland-Palatinate and the Saarland.
Stroke therapy in danger
Conclusion: the treatment and in the future, probably after-care of stroke in Germany are as good as never before. “However, could change this ideal Situation, because the width of the stroke care in danger”, warns, Helmuth Steinmetz. A recent judgment of the Federal social court to reduce the remuneration for stroke patients in smaller hospitals.
Stroke Units are threatened with closure?
What is the meaning of the judgment: hospitals have not received additional remuneration for the care of Stroke patients, if you were within 30 minutes of pure transport time of a severely affected patient in a special unit, such as the Thrombectomy, embarrassed. The current judgment is not now, however, to evaluate the pure transport time, but to measure the 30 minutes from the decision for a Transport.
Not to exceed 30 minutes, is almost impossible. “Especially smaller, regional Stroke Units will no longer have to log out then, because the compensation would be adequate. Patient care is compromised,“ fears the expert.
The Background for the court’s decision is hardly understandable. Certainly it is for the patient, the better, the earlier targeted therapy. But at least the time window, especially in the case of Thrombectomy with up to 24 hours not so small that the remuneration of an important period of time must not be also time more than 30 minutes. It remains to hope that the decision makers talk again about this issue, and for the benefit of the patient make a determination.