Ischemic Stroke: The First Pass Effect
It's been less than five years since, beginning with MR CLEAN, a series of landmark trials validated the role of clot-removing (thrombectomy) devices that can open up large vessel occlusions in the anterior circulation of patients experiencing acute ischemic stroke. But the field is moving fast. Mechanical thrombectomy devices known as stent retrievers (or stentrievers) and aspiration catheters are moving into the third generation.
The device market is growing rapidly too. According to Wells Fargo senior analyst Larry Biegelsen, in 2018, thrombectomy volume increased by 10,000 procedures to 38,000, driven by clinical trials that extend the treatment window for thrombectomy (according to a research note on Penumbra Inc. dated July 31, 2019). Looking forward, Biegelsen estimates that in 2019, the market will grow by more than 20% to 45,000 cases. By 2022, Wells Fargo models a treatment pool of 70,000. This is phenomenal growth for a medical device segment.
Until recently, the goal has been to get these effective treatments to as many patients as possible, largely by expanding the treatment window between stroke onset and the cut-off point beyond which mechanical recanalization of the occluded artery is deemed no longer effective [see 'Technologies to Watch in 2018: New Data and More Expansive Guidelines Give Ischemic Stroke a Push,' MedTech Strategist, April 20, 2018). This has been accomplished by a series of clinical trials that have demonstrated the efficacy of the treatments for patients 6 hours post stroke onset, then 8 hours out, and finally,
24 hours after first stroke symptoms, based on brain tissue viability as determined by imaging studies [see Figure 1).
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