Among people with the most common type of stroke – those caused by blocked blood vessels – those with dementia appear less likely than others to receive advanced clot-removal treatment, a large new study has found. .
The treatment, called mechanical thrombectomy, uses a device to remove a clot from a large vessel to restore blood flow to the brain. Mechanical thrombectomy has “significant absolute benefit” for stroke patients with large vessel blockage, particularly when used within six hours of symptom onset, according to the research.
In the new study, acute ischemic strokes – those caused by blockage of blood flow to the brain – tended to be more disabling in the group with dementia. Yet only 3.4% of these patients were treated with mechanical thrombectomy, compared to 6% of those without dementia, the researchers found. The procedure has a recommended time window of six hours, although treatment can sometimes be given up to 24 hours after symptoms start.
The study found no difference between the two groups in the use of intravenous anti-clot medications, which can be discontinued 4.5 hours after symptoms start. The findings were published Wednesday in the American Heart Association journal Stroke: Vascular and Interventional Neurology.
“The main takeaway from this is that patients with dementia have higher stroke severity early on. However, the number of thrombectomies was lower for this patient population,” the lead author said. study, Dr. Hamidreza Saber, researcher in neuro-intervention. at the University of California, Los Angeles, David Geffen School of Medicine.
About 1 in 10 people who have a stroke caused by a clot also have dementia, according to a recent scientific statement from the American Heart Association/American Stroke Association. This statement describes the “treatment dilemmas” for stroke teams who lack adequate research data to guide them in the care of people with dementia or disability prior to stroke.
Treatment teams might also be concerned that mechanical thrombectomy could cause brain hemorrhage in patients with dementia. In the study, people with dementia treated with mechanical thrombectomy were more likely to develop intracranial hemorrhage or bleeding in the skull (including the brain). But other blood vessel changes caused by dementia could explain this increased risk, the study notes.
The research looked at nearly 180,000 hospital admissions for acute ischemic stroke from October 2016 to December 2017. Saber said the study is one of the first nationwide to look at hospital admissions. hospital for acute ischemic stroke in people with or without dementia.
Limitations include that admissions data did not identify patients eligible for mechanical thrombectomy and how long had elapsed between the onset of stroke symptoms and hospital care.
Dementia in people who have undergone mechanical thrombectomy does not appear to increase the risk of death in hospital, or decrease the chance of a favorable outcome at hospital discharge, the researchers found, after taking into account consider relevant factors such as stroke severity, age and medical conditions. the story.
“This study shows that patients with dementia are excluded from thrombectomy treatment at a higher rate, although their outcomes from this treatment are not necessarily worse,” Saber said.
“This is a very exciting and eye-opening article,” said Dr. Gillian Gordon Perue, assistant professor of clinical neurology at the University of Miami in Florida. Using comprehensive, insurance-based inpatient care data, the research is a “first snapshot in a moment” of ischemic stroke treatment in US hospitals for people with and without dementia, it said. she declared. “This is an area where we need more data.”
Gordon Perue, who was not involved in the new study, co-authored the recent scientific statement on the treatment of stroke in people with dementia. She said the new study highlights existing disparities in the timeliness and appropriateness of stroke treatment for people with dementia.
Because stroke patients with dementia have been largely excluded from randomized controlled trials studying treatments that restore blood flow, “we don’t know what happens to these patients three months later,” Gordon said. Peru. “In the future, clinical trials need to include patients with dementia so that we can see long-term results.”
As the US population ages, the number of people with dementia is expected to increase. Saber said the next steps toward improving care for these people include using better tools to assess dementia and generating more data specific to people with the disease, such as markers that could predict how people undergoing blood flow restoration therapies will be fine.
“We want to provide precision medicine,” he said. “Not all dementia patients are the same, so which dementia patients would benefit the most from treatment, and which would not?”
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