Sunday, September 17, 2017

Awardee has seen stroke treatment transform


By AMERICAN HEART ASSOCIATION NEWS
http://news.heart.org










Jeffrey Saver, M.D., accepts the Meritorious Achievement award at the American Heart Association’s awards ceremony in June. (Photo by Tim Sharp)








The patient, young and pregnant, arrived at the hospital with a severe stroke. She couldn’t speak, comprehend or move the right side of her body.

When Jeffrey Saver, M.D., started his career decades earlier, there would have been little he could do to help the woman. But now it was 2006, and a lot had changed. The patient was treated with one of the first clot retriever devices designed to open a blocked artery in the brain, Saver said. She went on to function normally and gave birth to a healthy baby boy.

“An outcome that before was unachievable is now completely achievable,” said Saver, who has seen the world of stroke transform since he became a director of UCLA’s Stroke Center in 1995. “When I started, there was no proven treatment for stroke. I have been privileged to have my career occur in the first effective therapeutic era for stroke.”

Saver was recently honored in Dallas with a Gold Heart Award, the American Heart Association’s highest volunteer honor. Widely published, Saver’s contributions to stroke care, including systems of care and performance metrics, are immense. He has been the global or site principal investigator for more than 50 clinical trials. One of the most ambitious and groundbreaking was FAST-MAG, a first-of-its-kind study showing that paramedics can safely give intravenous medication to stroke patients in the ambulance.

It’s not surprising that Saver wound up in a medical career. Both his father and paternal grandfather were general practitioners. At age 3 Saver would go on house calls around Boston in his grandfather’s “1950s doctor’s car.”

Still, it was a challenging heritage, Saver said, because his love of math and science, a natural fit for medicine, competed mightily with his philosophical and linguistic interests. After some soul searching, Saver eventually found his home in neurology, where he has carved out a reputation for his tenacity and innovation in investigating stroke.

Saver said he was drawn to the intensity and emotional rewards of acute care and making a difference. The challenges were huge, and still are.

While stroke was the No. 3 killer in the United States when Saver finished his stroke fellowship in 1992, it has since moved to No. 5 thanks to increased awareness and treatment advances in recent decades.

“Clot-busting tPA — the ‘Drano drug’ — and clot retrievers are two therapies to open blocked arteries that have occurred over last 25 years,” he said.

“Once we proved that tPA worked, it was the effort of a generation to translate it into practice,” Saver said. “Emergency physicians were understandably reluctant, because it had risks and they didn’t have [all the knowledge] to make decisions on their own. And neurologists weren’t used to coming to the ER in the middle of the night and making those decisions.”

It was a 20-year effort of the AHA and the American Stroke Association to create a set of tools and policies that transformed the practice of stroke medicine in the United States, Saver said.

“Even more important was the notion of having designated stroke center hospitals and specialized stroke neurologists, with everyone working together to provide organized care,” he said. “Before it was Russian roulette whether or not a stroke patient got the best treatment, because an ambulance would deliver the patient to the nearest hospital instead of the one best equipped to treat the patient.”

Because of these and other efforts nationwide, the treatment rate for stroke patients with brain-saving clot-dissolving therapy tripled between 2004 to 2010. But the victories are mixed. One in six people will have a stroke in their lifetimes, and it’s the No. 2 cause of death worldwide, and a leading cause of serious disability.

With nearly 800,000 each year in the United States, “stroke is unfortunately still very common,” Saver said. “Although the per capita rate of stroke has been cut in half since 1990, the number of strokes is still increasing, taking into account people’s age — two-thirds of people who have a stroke are 65 or older.” Generally, stroke developments lag behind heart innovations, he said.

“It takes 10 years longer to develop something comparable for the brain. First, the brain and the brain vessels are more complex; we have a much more narrow margin of error,” Saver said.

“Second, there are somewhat fewer strokes versus heart attacks in the U.S. so it takes longer for us to recruit people into randomized trials and get definitive evidence of what works or doesn’t work.”
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