"In most patients suffering a potentially devastating stroke triggered by a blood clot retrieval of the clot with a medical device along with the standard drug therapy restored blood flow to the brain and reduced rates of death and disability four new clinical trials have demonstrated. The latest research confirms that compared with patients who get clotdissolving medicine alone those who also get the treatment known as intraarterial intervention are more likely to be discharged from the hospital and to go home in better shape. Intraarterial stroke treatment uses either a suction or stenting device to capture and withdraw blood clots lodged in the vessels leading to the brain. The devices are already in use at some comprehensive stroke centers across the United States and three designs are approved here. But many centers citing mixed findings on the devices benefits have either abandoned or have been reluctant to offer the treatment which is costly and complex to provide. Insurers also have been skeptical of the procedures value and many refuse to pay for it. The results of two of the clinical trials were published this week in the New England Journal of Medicine and presented at an international conference httpmy.americanheart.orgprofessionalSessionsInternationalStrokeConferenceInternationalStrokeConference_UCM__SubHomePage.jsp on stroke in Nashville. Two more studies described at the meeting offered further confirmation of the clotretrieval devices benefits. The new studies were hailed by some as game changers in stroke care UCLA stroke specialist Dr. Sidney Starkman said the presentations were greeted with standing ovations among neurologists and neurosurgeons at the conference. At UCLAs Stroke Center Starkman said weve seen how well it works and have a team and a system thats really ready to provide intraarterial stroke treatment. We were enthusiastic all along and wanted to get others to do the same. The new research is expected to usher in more widespread use of clotgrabbing technologies at stroke centers across the nation. It comes just a year after a three widely cited studies  also published in the New England Journal of Medicine  failed to show benefits http for stroke patients who got the additional therapy. In the two large studies published Wednesday researchers showed that more careful selection and speedy treatment of patients who got intraarterial therapy yielded clearer evidence of the treatments benefits. In both of the large clinical trials  one conducted in Canada the United States South Korea Ireland and Britain and the other in Australia and New Zealand  stroke patients needed to arrive at a participating hospital with a portion of their brain still undamaged by the lack of blood flow. Each of the hospitals performed extensive radiological scans to assess the extent of damage to the brain and locate and evaluate the size of the clot. Treatment also had to come quickly. The use of alteplase a clotdissolving medication also known as tPA is limited to otherwise healthy patients who arrive at a hospital within  to . hours of stroke onset. In the AustraliaNew Zealand study http_home treatment with a clotretrieving device had to be initiated within six hours of the onset of stroke symptoms and completed within eight hours. Compared with the  stroke patients who got clotdissolving medicine alone the  who got the twopronged treatment were nearly twice as likely to regain some neurological function after three days. Imaging results revealed that for those who got both treatments  of the brain tissue initially affected by a clot had blood flowing to it after  hours. Among the subjects who only got alteplase the median level of restored blood flow was . In the other study http involving  stroke patients treated with alteplase  of those who were also treated with an intraarterial device were still alive  days later and  were considered functionally independent. Among the rest  survived to  days and  were functionally independent. Both clinical trials were ended early when it became clear that the dual therapy was superior to clotdissolving medication alone. These are overwhelmingly unequivocally positive numbers said Dr. J Mocco director of cerebrovascular surgery for Mt. Sinai Health System in New York City. The studies suggest that on average for every . to  patients treated with intraarterial therapy one could be expected to have an outcome better than they would have had with alteplase alone. This is radically better than anything weve had said Mocco who was not involved with either trial. The studies ethnically diverse patient population also means the findings are likely to be widely applicable. At the same time Mocco cautioned that few U.S. hospitals  including those with specialized stroke centers  were ready to offer intraarterial stroke treatment. There are a great many centers that will report they have the capability to provide these services he said. But there are truthfully relatively few that have put in the effort and expertise to create the comprehensive teambased work flow needed to rapidly evaluate and treat these patients safely and efficiently. In the United States three clotretrieval devices are approved for marketing. Two are designed to capture a clot in a mesh pouch the Solitaire Flow Restoration stent retriever made by Covidien and the Trevo stent device made by Stryker Corp. The third is the Penumbra thromboaspiration device from Penumbra Inc. which suctions up a blood clot instead. The Canadaled trial was funded in part by the University of Calgary Alberta Health Services and the Heart and Stroke Foundation of Canada. The AustraliaNew Zealand trial was paid for by the Australian National Health and Medical Research Council the Royal Australasian College of Physicians the Royal Melbourne Hospital Foundation and the Heart Foundation of Australia. Both trials also received financial and infrastructure support from Covidien the maker of one of the devices. melissa.healylatimes.com Twitter LATMelissaHealy"