The time that elapses from the moment stroke strikes can determine a patient’s fate. Rambam is one of the leading hospitals in Israel and the only one in northern Israel offering brain catheterization – an essential lifesaving procedure requiring advanced professional expertise and technological know-how. This innovative procedure enables broadening the window of opportunity during which doctors can intervene and dissolve or extract the clot urgently from three to eight hours (from the onset of the stroke).
In Israel, a stroke occurs every 35 minutes, and 15,000 people are afflicted annually. Strokes have become the third highest cause of death, both nationally and globally. The statistics are similar to those of heart attacks, but strokes have more extensive consequences and entail a longer and more complicated recovery process.
Intra arterial catheterization has been made available thanks to a new Rambam staff member, Dr. Yaaqov Amsalem, who is a neuro-radiologist specializing in invasive neuro-radiology. He completed his specialty in France and received additional training in operating the advanced medical imaging facility at Rambam, in collaboration with the neurology team and with Dr. Gregory Telman. Dr. Telman is in charge of the treatment of stroke patients in the Department of Neurology, headed by Prof. David Yarnitsky.
What is a stroke?
85% of strokes are ischemic, and occur due to a sudden interruption of blood flow to the brain by a clot. This clot can develop locally or be generated in the heart or in other blood vessels and travel with the blood stream. The remaining 15% of strokes are a result of bleeding in the brain, and occur when blood leaks through a ruptured blood vessel into the surrounding area of the brain. They are called hemorrhagic strokes. Both types of stroke cause an oxygen deficiency in the brain and initiate a rapidly expanding process of brain tissue death. Clinically, impaired speech and paralyzed limbs are among the most common neurological symptoms.
Treatment of strokes in hospitals
The window of opportunity for treating a stroke and saving brain tissue is only several hours long. As time progresses, brain damage increases accordingly and fewer brain cells can be saved. Recent studies have shown that in cases of ischemic stroke the damage can be limited by injecting blood clot-melting substance into the vein (TPA). Treatment through injection is performed by a neurologist and is available in most neurology departments. This treatment is applicable up to three hours from the time of the stroke and has proved to be efficient in many cases. According to data collected in Israel, only 3-5% of Ischemic stroke patients reach the hospital within this timeframe and are able to receive such treatment. This low rate of treatment is mainly attributable to the lack of recognition by patients that their symptoms are indicative of a stroke.
The unique new treatment at Rambam
Invasive neuro-radiology is a medical field dealing with the diagnosis and treatment of problems involving blood vessels in the brain and spine, using catheterization as a substitute for a complex invasive surgical procedure. Dr. Amsalem is a member of a very exclusive professional team comprised of four physicians nationally, who perform brain catheterizations. A survey conducted in 2007 by the Israeli Neurological Association in collaboration with the Israeli Center for Disease Control, revealed that 77% of stroke patients arrive at the hospital over three hours after the stroke process has begun. These patients do not qualify for treatment by injection, hence, a brain catheterization may determine their fate. According to Dr. Amsalem, about 30% of these patients qualify for the invasive treatment. If they are unable to reach a medical facility with an invasive neur-radiology department in time, the outcome may be injury, severe disability or even death. Thus, Dr. Amsalem indicates that hundreds of patients in northern Israel may benefit significantly from this procedure.
How the innovative treatment method works ?
A brain catheterization may be performed by several different methods. In one method, an artery in the groin is penetrated and a catheter is inserted through it and pushed up to the neck. A second narrower catheter is channeled through the first one to the clot in the brain enabling injection a clot-melting substance directly and locally. This treatment is efficient up to six hours after the stroke begins. An alternative method is mechanical removal of the clot from the occluded blood vessel. This procedure is performed similarly to the local injection procedure, using two different medical devices. One is a tiny device called MERCI, which looks like a small corkscrew and is inserted through the first catheter (that has previously been inserted through the groin) to “unscrew” the clot. Another device, which resembles a butterfly net (CATCH), “catches” the clot and pulls it out. The success rate obtained through the use of these two devices is about 70%. A diagnostic catheterization mapping indicating the location and size of the clot must be performed prior to the clot removal process. This procedure together with the catheterization process takes two to four hours.
Limitations of the new treatment method
Not all strokes can be treated using these innovative procedures. The procedures are effective only in medium to severe cases of ischemic strokes, when the patient reaches the hospital three to eight hours after the stroke occurs and a CT scan indicates a medium to large blockage of blood vessel in the brain. In these cases, success rates are high, with 60% of patients who undergo these procedures experiencing full recovery!