Revolutionary Stroke Treatment Will Save Millions of Lives | Hacker News Reader

Revolutionary Stroke Treatment Will Save Millions of Lives

nytimes.com

80 pointsmhb27 comments

Sounds pretty helpful:

> The trial was so successful that it was halted early — given the findings, it was no longer ethical to keep adding patients to the control group. While 29 percent of patients in the control group (who were treated, when eligible, with alteplase, a type of tPA, alone) survived with at least a partial recovery of their deficits and were able to reclaim their independence, 53 percent of patients who received EVT saw the same positive outcomes. And while 19 percent of the control patients died, just 10.4 percent of the EVT patients did. Given that medical progress is often seen in decimal-point increments, these were staggering numbers.

Man. It's strange to think that if you were selected for this, there's a good chance you'd be in the control group, potentially taking nothing and still hoping it prevents you from dying, only to end up dying anyway.

For science, I suppose. But damn.

I mean, the reassuring part is that if the treatment is proven to be better than the standard of care, you'll receive it. Before then, for all you know, it could be worse.

Just a clarification because I've been getting downvotes, the control group still gets standard of care.

It’s interesting that the media is just picking up on this now. The first major trial results that showed benefits of thrombectomy was the DAWN trial and if I recall the data was first published in 2016-2017. The hospital I work at adjusted stroke treatment practices years ago to reflect this.

> High blood pressure and low blood pressure are each risk factors for stroke, and atrial fibrillation — an abnormal heartbeat — is, too

And obesity, and diabetes, and smoking, and hyperlipidaemia, and sedentarism...

We already have the cure but we sell the disease at every streets' corners

I got afib from years of running. I hear you about smoking, etc., but sometimes stuff happens. I was very glad they invented an effective treatment (an operation).

I had a stroke six months ago.

My blood pressure is a touch high, but nothing concerning. I do not have afib. I am a healthy weight, no diabetes, nonsmoker, good cholesterol levels, and between judo, BJJ, and snowboarding I exercise between 15-20 hours a week across 3-6 days. I am 39.

I woke up unable to move the right half of my body and unable to speak except maybe one word at a time with extreme effort. It was terrifying.

Thankfully, my clot broke up on its own in maybe an hour and a half and didn’t require medical intervention. I effectively recovered fully on the same day and was sent home the next.

Did you take any medication, that may cause blood cloth as a side effect? It may happen again...

Fellow BJJ player here – there have been numerous references to the increased risk of vascular injuries and stroke resulting from the high number of chokes that we routinely practice. One study, for instance, found that even brief interruptions in blood flow to the brain during a choke can result in cognitive deficits and other negative health outcomes (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678212/).

I'm very glad to hear you recovered quickly, and encouraged by the potential for new treatments to help save more lives.

There was no evidence of a vascular dissection in my case. It was either a clot or other piece of debris that made its way to my brain, potentially via a PFO.

I suspect the person you're responding to was just throwing that out carotid dissection as an example; the general risk factor with BJJ is vessel wall injury (which dissection is a subset of). Blood clots from vessel trauma in peripheral parts of the body can migrate to cause thrombosis elsewhere.

Chokes are a big cause of vessel trauma, but hard takedowns, pressure passes, accidental strikes from spazzy white-belts, etc. all count too. Anything that can cause major bruising, really.

To be clear, I'm not trying to argue that anyone should avoid BJJ due to cardiovascular risk, and the sport is probably a large net benefit to cardiovascular health on the whole - but it can certainly be a proximate cause of a stroke if you get unlucky.

Interesting, I hadn't heard about the bit about clots from vessel trauma in peripheral areas.

Thankfully I'm getting my PFO closed in two weeks. The left and right sides of the heart should be isolated systems, and a PFO is a hole that potentially allows a clot to travel from the body side to the brain side. Hopefully if this was related to that, closing the hole will prevent such a thing from happening in the future. Apparently if the hole is closed, a clot would likely travel to the lungs, which are significantly better at coping with it than the brain is.

Yes of course, but that's not the majority of cases. Some people also survive car crashes by not wearing their seatbelts for example.

I'm not saying this is a bad news, but we should't let people think medicine will bring a magic pill for all their issues when they're just slowly killing themselves with bad habits

Sure, but fluke things exists. I had one young, fit, healthy, thin and nothing was found. I saw quite a lot (most for sure) of people on the young-stroke ward who were in the same boat.

You saw other healthy young thin people, in the ward, because the people that had strokes that didn’t fit that demographic went to the morgue. Survivorship bias, not to say that OC is right, just pointing it out.

https://archive.ph/zZIi0

Ok, this is standard practice since early 2000s.

I trained in an ED at a comprehensive stroke center in the US, I would definitely disagree with "early 2000s." The early literature on thrombectomy and catheter-directed TPA showed no benefit, for reasons (eg poor inclusion criteria, kind of like doing cath for NSTEMI IMO). To my knowledge, in the US, prior to 2014ish this was not commonplace at all. I was highly skeptical until the MR CLEAN era studies (there were 3 or so all at once IIRC).

Happy to be corrected by neuro / neuro CC / non-US, maybe different at other shops.

In a rush out the door, sorry for typos / jargon.

(Congrats on item ID number 35 million, by the way. It's kind of poetic that your comment has the string "000" in it.)

,,but only when it’s performed quickly enough''

Sadly politics in the world makes this part really hard :(

Strokes are well-established as a very time sensitive condition. The standard mnemonic device for stroke detection is F.A.S.T.

Face drooping

Arm weakness

Speech problems

Time to go to the ER

If you or someone you see is having symptoms, rushing to medical care is the best way to stay alive and minimize impacts of a stroke. This new treatment (EVT) as well as older treatments (TPA) all work to remove the source of occlusion that prevents oxygen from reaching parts of the brain.

My father died last year in stroke because he forgot to take his blood pressure medication and by the time the ambulance arrived it was too late to do anything.

My condolences.

Thank you

> Strokes are well-established as a very time sensitive condition.

That makes me afraid of living in the upper floors of any tall building. I can't stop thinking the additional time it would take to rush me, or someone in my family, out, in case of medical emergency, may be the difference between a quick recovery, death, or perhaps becoming a vegetable afterwards.

I honestly wonder how much worse response times are for a high-rise building - assuming the lifts are working it wouldn't have expected it to make a major difference.

Personally I'm more worried about living alone. If $thing happens (stroke or even stupid accident) then my cat is unlikely to ring 999 on my behalf, give my address or unlock the front door; all of which seem like more of a delay than an elevator.

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