UPDATE: Medical societies update stroke guidelines

A bevy of cardiac medical societies updated their guidelines for stroke treatment yesterday to take into account new devices and technology, including left atrial appendage occlusion devices, stent retrievers and thrombectomy devices.

The American College of Cardiology, Heart Rhythm Society and Society for Cardiovascular Angiography and Interventions have updated their guidelines to include the benefits of left atrial appendage occlusion for patients with atrial fibrillation.

The groups suggests that the use of LAA occlusion devices, such as Medtronic‘s (NYSE:MDT) Watchman device, may lower the risk of stroke in select patients. The societies recommended the treatment for patients who are contraindicated for or unable to take anticoagulation drugs, which they said is the standard of care.

“This document highlights the critical issues surrounding left atrial appendage occlusion therapies. We aimed to facilitate the alignment among patients and their families, primary care physicians, general cardiologists, and additional heart team members and procedural specialists. We also identified the need to collect robust clinical data on outcomes for patients who are treated with these devices in clinical practice, especially because in some cases, the evidence for some devices in use is sparse,” writing committee chair Dr. Frederick Masoudi of the University of Colorado Anschutz Medical Campus said in prepared remarks.

The medical groups said that they expected to see new devices for LAA occlusion and an increase in the use of the devices in the future, and supported a focus on data collection as their use grows.

The societies said the update was the first in a series that addresses new technology integration into the guidelines for patients with atrial fibrillation.

The American Heart Association/American Stroke Association said yesterday that it updated treatment guidelines for patients suffering from ischemic stroke to include endovascular treatments, such as stent retrievers and other thrombectomy devices.

The decision supports devices used to remove clots in patients who have obstructions in the large arteries supplying blood to the brain, according to a new focused update published in the American Heart Association journal Stroke.

The AHA/ASA said that optimal treatment still lies with the intravenous use of tissue plasminogen activator, used to break down clots, but recommends the use of retrieval devices in cases where obstructions continue after the medication has been administered.

“What we’ve learned in the last 8 months, from 6 new clinical trials, is that some people will benefit from additional treatment with a stent retrieval device if a clot continues to obstruct one of the big vessels after tPA is given,” update lead author Dr. William Powers of the University of North Carolina at Chapel Hill said in a press release.

The decision was based upon the results of randomized clinical trials published since 2013, when the last treatment guidelines were issued. These included 3 trials of Medtronic’s Solitaire stent retriever device and Penumbra‘s Mr Clean trial of its Ace64 aspiration thrombectomy device, the companies said.

“Since Medtronic’s invention of the first stent retriever in 2007, our commitment to fighting stroke has not wavered. We helped to bring the five global trials to bear that have proven this device can be a game changer in the treatment of stroke, reducing functional disability in patients. The AHA/ASA guidelines have validated our commitment to and belief in this technology, and we will work hard to make it accessible to as many stroke patients as possible,” Medtronic neurovascular business president Brett Wall said in a prepared statement.

“We are pleased that the American Heart Association/American Stroke Association updated their acute ischemic stroke treatment guidelines to support the endovascular treatment of stroke patients. This is another step forward for those patients who can benefit from mechanical thrombectomy as shown by the landmark Mr Clean study and subsequent confirmatory trials that support endovascular treatment over medical management alone,” Penumbra CEO Adam Elsesser said in a press release.

The update suggests a preference for stent retrievers over other mechanical thrombectomy devices, but adds that the use of other devices may be reasonable based upon a physician’s clinical judgement.

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