Intra-arterial Thrombolysis for Stroke

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Endovascular therapy is a type of interventional emergency stroke treatment. Interventional means that the treatment is a procedure, as opposed to a medication, which can be given as a pill or IV.

Emergency Stroke Medication

So far, the well-known emergency treatment for stroke is TPA, which was established about 20 years ago. TPA is a medication called tissue plasminogen activator, a powerful blood thinner that is injected into a blood vessel, usually in the arm.

The medication rapidly travels through blood vessels to the brain where it works by dissolving the blood clot that is responsible for causing an ischemic stroke.

Another, even newer and more potent stroke therapy is called intra-arterial thrombolysis, a type of endovascular interventional procedure used to directly dissolve a stroke producing blood clot.

Endovascular Therapy

Endovascular therapy is a type of procedure that involves placing a tube, called a catheter, directly into a blood vessel. Intra-arterial therapy means that the catheter is placed into an artery, which is the type of blood vessel that becomes blocked during a stroke. Thrombolysis means that the process destroys a blood clot.

The procedure of intra-arterial thrombolysis for stroke must be done very quickly, usually within 6-12 hours after the initial stroke symptoms begin. Generally, intra-arterial thrombolysis requires a preliminary imaging study, such as a Brain MRI/MRA to pinpoint the exact location of the blood clot in the brain.

Then, the catheter is inserted into an artery through an easy to reach part of the body, such as the arm or groin. The catheter contains a powerful blood thinning medication called alteplase. The catheter is then progressively and carefully thread all the way into the blocked artery in the brain until the blood clot is reached.

At that point, the blood thinning medicine is injected right into the blood clot for the purpose of dissolving it.

Experienced doctors must perform this intricate procedure and the preparation involves a team of neurologists, radiologists, and possibly surgeons.

MR CLEAN

The Dutch Heart Foundation and others funded a recent experimental study called MR CLEAN in the Netherlands. It was designed to evaluate the safety and effectiveness of intra-arterial thrombolysis for stroke treatment. The trial results, published in the January 2015 issue of the New England Journal of Medicine, included 500 stroke patients from 16 medical centers in the Netherlands.

Of the 500 stroke patients, 233 received intra-arterial thrombolysis and 267 received the usual stroke care. The results showed that the patients who received thrombolysis experienced a better functional outcome as measured by the modified Rankin score, a rating system that measures independence after a stroke. The intra-arterial thrombolysis group did not suffer from more side effects or from more negative consequences than the non-thrombolysis group.

What Does This Mean for You?

If you ever have a stroke, intra-arterial thrombolysis is only an option for you if you arrive at the hospital within a few hours after your stroke symptoms first start. There are strict stroke protocols regarding which patients can receive intra-arterial thrombolysis because of safety issues. If you qualify for intra-arterial thrombolysis, you or a family member will have to agree to the procedure by giving consent. But there is no time to hem and haw over the decision because once a narrow time window elapses, the treatment is no longer proven to be effective and may even be dangerous.

If you have already received intra-arterial thrombolysis, you will certainly need some time to recover from the procedure. Some patients experience a complete recovery with no effects of stroke, while others experience a smaller stroke than they would have had without the emergency procedure.

Source

MR CLEAN Investigators, A randomized trial of intraarterial treatment for acute ischemic stroke, New England Journal of Medicine, January 2015

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