New Stroke Reversal Treatment at New York Methodist Hospital

Aug 17, 2011

Stroke is now the third-leading cause of death and a leading cause of disability, with almost 800,000 Americans experiencing a stroke every year. A stroke-which is actually a "brain attack"-comes in two forms: ischemic, caused by the blockage of a blood vessel supplying the brain, and hemorrhagic, caused by bleeding into or around the brain.

Eighty-three percent of strokes are ischemic strokes, which occur when blood clots or other particles block arteries to the brain and reduce blood flow, depriving the brain cells of oxygen and nutrients. Within minutes, cells may begin to die.

Ischemic strokes can be caused by complications from smoking, high cholesterol, diabetes, and high blood pressure (hypertension), which all can lead to the narrowing of arteries in the brain. Hemorrhagic strokes occur when a blood vessel in the brain leaks or ruptures. Uncontrolled hypertension and weak spots in blood vessel walls (aneurysms) can cause hemorrhages.

When a patient with an ischemic stroke is taken to the emergency room within three hours of the stroke's occurrence, a clot-busting medication called tPA (tissue plasminogen activator) can be administered intravenously or directly to the site of the clot. This medication may help to reverse the stroke by breaking up the clot and allowing blood flow to reach the brain again, saving brain cells. However, this is not an option if the patient arrives in the emergency room after three hours, nor is it an option for hemorrhagic strokes.

Additional options for treatment of stroke are now available at New York Methodist Hospital, which recently welcomed Michael J. Ayad, M.D., a neurosurgeon with a Ph.D. in neurophysiology, as attending physician in the Division of Neurosurgery. Dr. Ayad, an expert in stroke care, is devoted to research in the area of blood flow to the brain, offers advanced techniques for the treatment of strokes.

"We are fortunate to have someone with Dr. Ayad's skills as part of our staff," said Martin Zonenshayn, M.D., F.A.C.S., chief of neurosurgery at NYM. "We are now able to offer our patients comprehensive care for a full range of cerebrovascular diseases."

"There have recently been many advances in the treatment of stroke," said Dr. Ayad. One of the procedures that NYM can now offer is a "stroke reversal" alternative to tPA, utilizing the Penumbra System, first approved by the FDA in 2009. This procedure enables the neurosurgeon to remove blood clots through the femoral artery.

The Penumbra System is a "tiny vacuum cleaner for the brain," which suctions out blood clots through a catheter attached to a pump. This procedure can result in a successful reversal of stroke, up to eight hours after its occurrence. The device was named "Penumbra" (shadow) because of the "halo" of oxygen-deprived but nevertheless viable tissue surrounding the permanently injured portion of brain, which can be saved if the clot is removed.

"Even with the advanced technology we have, stroke reversal is still dependent on the amount of time the brain cells have been deprived of oxygen," said Dr. Ayad. "But in collaboration with the Department of Neurology, the Division of Neurosurgery and the Emergency Department, we will be creating well-informed teams to mobilize quickly, at all hours of the day, potentially saving brain, and lives."

The Merci System, introduced in 2006, is another option being offered for removing blood clots from the brain. With the Merci System, a catheter is also inserted into the femoral artery, but it has a corkscrew-shaped device attached to the end, used to physically spear and remove the blood clot.

Dr. Ayad is also able to provide care for people with a cerebral arteriovenous malformation (AVM), an abnormal connection between arteries and veins in the brain, which can lead to hemorrhage and stroke-like symptoms, such as difficulty speaking, weakness, numbness, vision loss or severe unsteadiness. AVMs can be treated either by making an incision into the skull and removing the abnormal veins and arteries comprising the malformation (known as resection), or by using a procedure known as embolization, in which a catheter blocks the abnormal feeding arteries with a type of "tissue glue," reducing blood flow into the abnormality, thus significantly decreasing chances of brain hemorrhage. A similar technique using platinum coils is used to treat intracerebral aneurysms.

"Dr. Ayad is one of very few people in New York City who can treat aneurysms and AVMs utilizing either an open surgery or an endovascular approach, depending on the patient's need," said Dr. Zonenshayn. "This provides the patient a unique and unbiased approach because treatment is not limited."

"In certain cases, after a stroke or following a hemorrhage, brain swelling can occur," said Dr. Ayad. "In cases like these, we are also equipped to do a decompressive craniectomy, during which a portion of the skull is removed in order to provide room for the brain to swell safely."

Dr. Ayad comes to NYM from Vanderbilt University Medical Center's Department of Neurological Surgery. "I am excited to be at NYM, an institution that is willing to offer the most advanced techniques when it comes to stroke care and other neurological disorders," said Dr. Ayad. "I am looking forward to a multidisciplinary approach to treat complex cerebrovascular diseases."

For more information, please call the Division of Neurosurgery at 718-246-8610.

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