The Medical Minute: Solitaire for stroke -- It's not a game

By Kevin M Cockroft

Stroke is the fourth leading cause of death in North America -- down from third. Despite this "improvement," stroke remains the leading cause of adult disability. Ischemic strokes, caused by blood vessel blockages, are by far the most common type of stroke. For ischemic strokes, early intervention is crucial. The only drug FDA approved for the treatment of ischemic stroke is tissue plasminogen activator (tPA). Unfortunately, this drug must be given very soon after stroke onset, within the first three hours for most people and up to four and a-half hours for some.

The Solitaire device, produced by Covidien Inc. of Irvine, Calif., is the first of a new class of devices called stent-retrievers to be approved in the United States for the treatment of . Devices like Solitaire, which mechanically break up and remove clots, can be used up to eight hours or longer after a stroke, thus increasing the time window for patients to be treated.

Unlike the first generation retrieval devices, Solitaire is relatively easy to use and has a high success rate at opening blocked arteries. The device uses a retrievable basket-like stent to capture the clot, allowing it to be pulled from the blocked vessel. Patients suffering a stroke from a large artery blockage tend to make a much better recovery if the vessel is reopened than if the blockage is left in place or cannot be removed. Penn State Hershey Medical Center is the first and only hospital in this region to have access to this new, innovative device.

Despite advances in the treatment of stroke, many patients still do not make it to the hospital early enough to benefit from these advances. It is important for patients to remember the of stroke:

-- sudden weakness of the face, arm or leg;
-- sudden difficulty speaking or understanding speech; and
-- a sudden, very severe headache.

The sooner patients get medical attention the more treatment options they will have and the more likely it will be that they will receive a beneficial stroke treatment. Even though it may not hurt, a stroke is a medical emergency where minutes matter early on, for both initial treatment and future recovery.

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