Newswise — Just as angioplasty and stents were a medical breakthrough for cardiac patients, a new set of comparable tools and procedures hold promise for those who suffer deadly and debilitating strokes.
Although advances in cardiovascular disease treatment in the past 30 years have saved countless lives, stroke remains the third-leading cause of death in the United States and the leading cause of disability.
Recent advances in stroke treatment, including carotid artery stenting (CAS) " a challenging procedure in which a tiny, mesh-like metal tube is placed in the arteries leading to the brain to prevent blockages " are helping physicians intervene sooner and prevent potentially debilitating brain damage or death. Keeping the carotid arteries open is critical in preventing strokes because the carotids are what interventionalists call the "highway to the brain."
The key challenge now is to train sufficient numbers of physicians throughout the United States in how to use these new tools, and that's why the Society for Cardiovascular Angiography and Interventions (SCAI), the leading medical association for interventional cardiologists, recently became the first organization to offer physicians multidisciplinary training to help stop strokes. SCAI has launched Advanced Course in Carotid Stenting, a course to train physicians from around the country in using an array of new treatments to stop strokes more quickly.
Interventionalists are at the leading edge of stroke treatment. In recent years, advances in stenting, as well as new catheter-based treatments to remove clots from the brain, have provided new hope in treating a stroke sooner than ever before.
"If you look at where we are with stroke, it's a lot like where we were 25 or 30 years ago in treating heart attacks," said Christopher Cates, M.D., FSCAI, who directs the course. "People often come in too late to receive clot-busting medication. They're in the hospital for a long time. If they live, they go to a nursing home or long-term care facility. Very few people who get in on time get drug therapy and almost no one gets stenting."
Dr. Cates envisions progress that will someday make stroke manageable in the same way that heart attack is today. "Heart attack death rates have dramatically fallen and disability rates have dramatically improved because of interventional treatment," stresses Dr. Cates. "Early data show dramatic improvements in results for stroke patients when they come in early enough and get the clot either retrieved or stented to stop the stroke."
The Advanced Training Course gave interventionalists, who have experience using catheter-based treatments, the opportunity to work with experts from other specialties " including radiologists, neurologists and neurosurgeons " to transfer their experience in catheters from the heart to the brain. In addition to CAS, the course offered the first intracranial stenting simulation (stenting of the brain arteries) and the first opportunity for cardiologists to simulate mechanical clot removal in the brain using a new catheter-based device with a tiny corkscrew that removes a clot from the brain and allows blood to flow.
The goal of the new program is to help prepare physicians to deliver these therapies in medical centers across the country. This effort was initiated in February 2007 by representatives from interested medical disciplines, industry and government who convened the first Stroke Roundtable, an assembly intending to develop guidelines and conduct research on stroke. SCAI offered is first course in acute stroke intervention in late 2007, and two additional courses are planned for 2008.
Increasing the number of experienced practitioners will also facilitate data collection. SCAI hopes to launch an Investigation Device Exemption (IDE) registry study, which will allow experts to study the safety and effectiveness of emerging stroke therapies. Data pooled from multiple sites will inform best practices and identify those who would benefit the most from interventional treatment.
"As treatments and technologies advance, interventionalists, together with neurologists and other specialists, have the opportunity to dramatically impact the effects of stroke," said Bonnie Weiner, M.D., MSEC, MBA, FSCAI, president of SCAI. "Just as we've seen a significant improvement in the treatment of heart disease, we hope this program will help launch the next wave of treatments for stroke. In the future, we hope that wherever a patient lives in the United States, he or she will have access to an interventionalist working with a team of specialists who can stop a stroke and prevent strokes in those at risk."
About SCAIHeadquartered in Washington, DC, the Society for Cardiovascular Angiography and Interventions is a 4,000-member professional organization representing invasive and interventional cardiologists in 70 nations. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI's annual meeting has become the leading venue for education, discussion, and debate about the latest developments in this dynamic medical specialty.
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