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A team at Valley Hospital, led by Dr. Dorothea Altschul, has been participating in a national trial called the DEFUSE 3 trial that focuses on treatment of acute strokes. In this trial, patients are treated using a procedure called a thrombectomy, which yielded such significant results for patients that the trial was halted because the thrombectomy proved to be beneficial before the endpoint was even reached and required no further data.

Why Thrombectomy Is an Important Procedure for Stroke Patients

When a blood clot gets lodged in one of the major arteries in the brain, it suddenly cuts off blood supply to a large portion of the brain, leading to stroke symptoms. Thrombectomy can physically remove a blood clot from the brain and restore the flow of blood and oxygen delivery to the tissues.

There are many ways to dislodge or dilute a blood clot, including a medication called Alteplase. However, if the blood clot is large, sometimes drugs alone cannot clear it. Additionally, those kind of “clot-buster” drugs must also be administered within three to 4.5 hours of symptom onset and are not always an option for everyone.

Thrombectomy allows large clots to be removed in a timely manner. The procedure takes approximately 30 minutes and immediately restores blood flow. Approximately one in four patients who undergo a thrombectomy will have a complete reversal of symptoms or a favorable outcome at 90 days, which means they can live independently following their stroke.

Significance of the DEFUSE 3 Trial

Thrombectomy has been shown to be beneficial when performed within six hours of symptom onset. However, the DEFUSE 3 trial demonstrated that the time window can be extended up to 16 hours after stroke onset.

This is important because many individuals who experience a stroke do not receive medical attention within the first six hours of symptoms. They may have had a stroke while sleeping and woken up to symptoms, or they may have been in another situation where circumstances prevented prompt medical care.

Conventionally, if you had a stroke and did not receive medical attention within the first six hours, you would not receive any stroke-specific therapy. The DEFUSE 3 trial provided patients with thrombectomy up to 16 hours following stroke symptoms, providing a potentially life-changing treatment option that was previously unavailable.

Sharing Findings With Colleagues

Dr. Altschul has been invited to participate at the International Stroke Conference (ISC) taking place in Los Angeles, California, in January 2018, where the results of the DEFUSE 3 trial will be presented. As the world’s premier meeting dedicated to the treatment of cerebrovascular disease, the ISC will be an opportunity for Dr. Altschul to share her experiences, potentially leading to adoption of thrombectomy as a treatment option for patients up to 16 hours following their stroke and improving patient outcomes. At the same conference, the American Heart Association/American Stroke Association guidelines for treatment of ischemic stroke will be announced.

Dr. Altschul’s Vision

Dr. Altschul is passionate about delivering excellent patient care as well as exploring new treatment modalities to improve the lives of her patients. She believes it is incredibly important to offer patients treatment for stroke in whatever way possible. Stroke is the leading cause of disability in the United States. Facing life with a disability is heartbreaking to her, and this trial allowed her to offer treatment up to 16 hours after stroke onset instead of the conventional six hours.

This project has her offered her the opportunity to stay current with the newest techniques and research developments as well as given her the privilege of working with some of the greatest stroke specialists in the country, including clinicians at Stanford University and Columbia University. She engages in extracurricular research because it not only makes her a better physician but also brings cutting-edge therapy to patients of Valley Hospital in New Jersey.