Thrombolytic treatment starts while the patient is lying in the scanner. The thrombectomy team can see from the scan image how the blood clot can be sucked out through a catheter.
Patients who wake up with a blood clot that formed in their brain during the night could not previously be treated. This situation has been drastically changed by development in recent years of medical thrombolysis treatment and thrombectomy procedures.
For patients, quick treatment means that less brain tissue is destroyed. This increases their chances of survival after a blood clot.
New opportunities with MR markers
Medication to break up blood clots (thrombolysis) was previously only administered up to 4.5 hours after the initial blood clot occurred. After this, there is a greater risk that the treatment will lead to brain haemorrhage. Therefore, a decisive factor for treatment has been the length of time the patient has had the blood clot.
Rigshospitalet has helped identify markers that can show whether the patient is at risk of a brain haemorrhage. Patients who are not at risk can now receive thrombolytic treatment, even though the time of blood clot is not known.
"We have previously not been able to treat patients who, for example, wake up with symptoms of a blood clot in the brain, as we do not known the time of the first symptoms. We have been able to demonstrate that, using MRI markers, we can give thrombolytic treatment to this group without significant increased risk of haemorrhage. This means that we can treat more patients,” said Helle K. Iversen, a consultant at the Department of Neurology.
In 2018, a total of 371 patients with a blood clot in the brain received thrombolytic treatment at Rigshospitalet. This is an increase of 20% compared with 2017. The new treatment criteria were introduced in 2018.
Rigshospitalet has a trombolysis service for patients in the Capital Region of Denmark every other day, with the intervening days being covered by Bispebjerg Hospital.
Treatment up to 24 hours after blood clot
The number of patients treated with a thrombectomy also grew by 20 percentage from 2017 to 2018. In 2018, 230 patients underwent a thrombectomy at Rigshospitalet. A thrombectomy is a specialist procedure in which a neuro interventional radiologist sucks large blood clots out through a catheter inserted in the groin.
Previously a thrombectomy would only be conducted up to six hours after the initial blood clot took place, because we did not have methods to determine for sure whether brain tissue could be saved. Recent international studies now show that the brain tissue in some patients can be saved many hours after the initial blood clot. Therefore, the thrombectomy team now treat patients up to 24 hours after the blood clot.
"Of course, there is no guarantee that the patient will recover after the blood clot. But the new effective method means far more patients now have a better chance of recovery. Our technology is constantly being refined, and therefore we expect that in the future we’ll be able to treat even more using thrombectomy,” said Ilse Vejborg, head of the Department of Diagnostic Radiology.
All patients in the Capital Region of Denmark and Region Zealand receive thrombectomy treatment at Rigshospitalet.
Quicker treatment after merger
Not only are more patients being treated, a group of patients are also receiving treatment more quickly.
One year ago, Rigshospitalet gathered hyperacute treatment of thrombosis in the brain at Blegdamsvej. This saves transport time for patients who first receive thrombolysis and then undergo a thrombectomy, since they no longer have to be transported between Glostrup and Blegdamsvej.
A blood clot in the brain will cause asphyxia, with two million neurons dying every minute. Therefore, quick treatment to restore the blood supply is crucial.
“For patients treated with a thrombectomy, the merger of the two functions has resulted in a time saving of 35 minutes because of the reduced need for transport. Transport time would have resulted in the loss of 70 million neurons. We’ve also managed to keep our door-to-needle time to 16 minutes for patients who are first treated with thrombolysis and then a thrombectomy,” said Helle K. Iversen.
The time from when the patient is collected by ambulance to treatment start is called the door-to-needle time.
Hyperacute treatment of blood clots in the brain takes place at the Neuroscience Centre and the Centre of Diagnostic Investigation with close cooperation between neurologists, neurology nurses, radiographers, neuro-radiologists, neuro interventional radiologists, neuro-anæsthatists, porters, the Department of Clinical Biochemistry, and the Trauma Centre.
After the hyperacute process, patients are transferred to a ward at Glostrup Hospital.