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| Endovascular recanalisation therapy effective in acute ischaemic stroke |
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06 February 2006
For stroke patients not eligible for intravenous thrombolysis, endovascular recanalisation therapy (ERT) seems to be a relatively safe and effective option, according to a report in the February issue of Stroke.
Recanalisation or revascularisation therapies are increasingly being offered to patients with acute ischaemic stroke who present outside the 3-hour time window or have other contraindications to systemic thrombolysis, the authors explain. "Major advantages of the endovascular approach are the proximity of the catheter tip to the intracranial site of the occlusion (local use of thrombolytics), probably a greater time-window for treatment, lower doses of thrombolytics, and the possibility of additional use of mechanical devices," Dr Jae H. Choi from Columbia University Medical Center, New York said. "The results of the PROACT studies suggest endovascular treatment in a defined group of stroke patients is safe and effective."
The group reviewed ERT results from 31 patients treated at Columbia University Medical Center and estimated nationwide usage and outcomes of ERT. Twenty-six of these patients received intra-arterial thrombolytic drugs, and twelve of these patients had combined pharmacological and mechanical recanalisation therapy. The other five patients were treated with mechanical devices only. Overall, 77% of the patients achieved partial recanalisation, including 42% who had total recanalisation. Seven of the patients (23%) had post-procedural haemorrhage, and six of these died. Of the survivors, 18 were transferred to rehabilitation hospitals or nursing homes and four were discharged home.
Nationwide statistics indicate that only 1.19% of stroke patients between 1999 and 2002 underwent intravenous thrombolysis. Fourteen percent of these thrombolysis patients also received an angiogram, suggesting that they underwent ERT. In the nationwide sample, among those who had an endovascular intervention, 15% died, 6% had intracranial haemorrhage, 39% were discharged home either with or without home health care, and 43% were discharged to rehabilitation or nursing facilities.
"Each method, either endovascular recanalisation therapy or systemic use of thrombolytics, has its advantages and disadvantages, but they may coexist for the greatest possible benefit of ischaemic stroke patients," Dr Choi concluded. "However, the exact range of potential or danger of both methods has not been defined well or precisely enough. It is our task to find safe, effective, and feasible ways to treat acute ischemic stroke."
Reference:
Stroke 2006; 37 (2): 419-424.
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