Local doctors add tool to fight stroke

Hospitals in St. Petersburg and Tampa add a vacuum to their arsenal.

By LISA GREENE, Times Staff Writer
Published February 5, 2008

Tampa Bay area doctors have a new tool to save brain cells and more of patients' ability to walk, talk and live independently after a stroke.

Called the Penumbra System, the device sucks stroke-causing blood clots out of the brain. It's designed to restore blood flow, minimizing permanent damage.

"Essentially it's like a little vacuum cleaner," said Dr. Lee Jensen of the University of Virginia, president of the Society of NeuroInterventional Surgery.

The device is a promising new approach to treating strokes, say local doctors who have tried it.

"This is the next generation," said Dr. Ali Malek, director of the neurological intensive care unit at Tampa General Hospital. "This is our first new device in quite a while."

Bayfront Medical Center in St. Petersburg became the first hospital in Florida to get the newly approved Penumbra last week. Tampa General hopes to get its device this week. St. Joseph's Hospital and Morton Plant Hospital, which participated in clinical trials of the device, are considering getting it as well.

"We're just happy to have another tool in our arsenal to help stroke patients," said Tom Bruce, Bayfront's administrative director of radiology.

More than 150,000 Americans die from strokes each year, making it the nation's third-largest killer. Last year, stroke-caused disabilities cost more than $62-billion.

Proponents say the device gives doctors more time to remove blood clots and to do so more safely than with a slightly older device that uses a different technique.

The Food and Drug Administration approved the Penumbra last month. Company officials will present results of a trial using the device at a conference later this month.

But Malek and Dr. Nasser Razack, the interventional neuroradiologist who signed Bayfront up for the Penumbra, have been watching it since last year.

"We're in a field where the technology is evolving very rapidly," Razack said. "Ten years ago, this wasn't done."

When a blood clot strikes, doctors can give a drug to dissolve the clot if the patient gets to the hospital within three hours. A device like the Penumbra that reaches the clot inside the artery can be used within an eight-hour window.

To use the Penumbra, doctors first scan the brain to find the clot. Then they insert a narrow tube, called a micro-catheter, into a blood vessel and run it up to the clot. The Penumbra breaks up the clot and sucks it out through the catheter.

Doctors say the device could be better in some cases than an existing device that works more like a corkscrew. The new tool is designed to have a lower risk of sending small clots elsewhere, and it doesn't have to be maneuvered through the clot.

But it's too early to say whether the Penumbra's initial promise will stand up, doctors cautioned. In some cases, existing technology may work better; in others, nothing can help.

"The exciting thing is, it gives you a third option," Jensen said. "That's what we need in the treatment of stroke. We just need more options."

The cost of the treatment is $5,000 to $6,000 per patient, and most insurers are expected to cover it.

Even with the new device, the critical challenge remains: getting stroke patients to the right place fast enough to help them.

"Half the problem is public awareness," Razack said. "I wish we could put a big billboard on the highway."

Malek has seen too many people come to the hospital only after seeing whether a good night's sleep would help their stroke symptoms go away.

"The biggest problem we have is that people don't recognize it's a stroke and that they need to get to us immediately," he said.

Some stroke patients can't be helped if their stroke is caused by bleeding, rather than a blood clot. And even strokes caused by clots can be different, depending on their size and location and how they form.

Still, far too many patients who could be helped don't get to the hospital in time to see an interventional doctor - one who can send a device or drug through the arteries. Only about 5 percent of stroke patients get such treatment, Razack estimated.

"The way I see this is like heart attacks 10 years ago," he said. "Ten years ago, if you had a heart attack, you mostly went into surgery. You didn't get immediate intervention."

Lisa Greene can be reached at lgreene@sptimes.com or 813 226-3322.


It may be a stroke

If these symptoms come on suddenly, call 911:

- Numbness or weakness, especially on one side of the body.

- Confusion, trouble speaking or understanding.

- Vision loss.

- Trouble walking, dizziness, loss of balance or coordination.

- Severe headache.

Are you at risk?

Risk factors for stroke include:

- High blood pressure

- Smoking

- Diabetes

- Other heart disease

- Inactivity

- Obesity

Source: American Stroke Association