Comparison of Treatment Techniques after Ischemic Stroke

Intracranial stents that keep brain arteries open and the delivery of tPA directly to the brain are the most effective treatment options for ischemic stroke, new research shows.

Compared to other treatments, such as intravenous delivery of tissue plasminogen activator (tPA) and angioplasty without stenting, intracranial stents that keep brain arteries open and the delivery of tPA directly to the brain (intra-arterial tPA) are the most effective treatments for acute ischemic strokes.

The new research from the American Heart Association (AHA) found that, for patients who were treated with one or more therapies within 8 hours of ischemic stroke symptom onset, blood flow was restored in 76% of patients who had stents placed and 72% of those who received intra-arterial tPA. Blood flow was only restored in 69% of patients who received other drug techniques or interventions.

“Essentially, there is no standard currently as to which interventions are performed for acute stroke in this country,” said Rishi Gupta, MD, senior author of the study and an assistant professor at Vanderbilt University Medical Center’s Department of Neurology. “We decided to study treatment at 12 of the busiest stroke centers in the country to determine which of the therapies currently in use may be yielding the best results in terms of opening the blood vessel without creating hemorrhage.”

The researchers used a number of treatment techniques for the study, according to the AHA:

• intra-arterial tPA

• intracranial stenting

• intravenous delivery of tPA via the arm

• Merci Retriever™ — a corkscrew-like device that is threaded into the blocked blood vessel to grab and pull out clots

• Prenumbra™ aspiration catheter — uses suction to remove blood clots

• glycoprotein IIb/IIIa antagonists

• angioplasty (without stenting)

Altogether, 1,056 severe stroke patients were included in the study, and 534 of these patients “received more than one therapy, and 75 percent of the time (or in 400 patients), it was successful.”

According to Gupta, the next step for the researchers is to determine if the initial success of intracranial stents and intra-aterial tPA continues to be effective after three months of follow-up.

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Muthiah Vaduganathan, MD, MPH | Credit: Brigham and Women's Hospital
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