Public release date: 13-Mar-2013 [ | E-mail | Share ]
Contact: Mark Wheeler mwheeler@mednet.ucla.edu 310-794-2265 University of California - Los Angeles
When someone has a stroke, time equals brain. The longer a stroke is left untreated, the more brain tissue is lost. Since the only proven treatment a clot-busting drug works in less than half of patients, stroke physicians had high hopes for a mechanical device that could travel through the blocked blood vessel to retrieve or break up the clot, restoring blood flow to the brain.
But in a recently completed multi-site trial in which UCLA served as the clinical coordinating center, researchers found there was no overall recovery benefit to patients treated with clot-removal (embolectomy) devices, compared with standard post-stroke care, which includes monitoring blood pressure and ensuring the brain is receiving oxygen.
The study also found that using brain scans to identify which patients might be the best candidates for embolectomy did not lead to better outcomes for those patients.
The study was sponsored by the National Institutes of Health, and the results appeared in the March 7 edition of the New England Journal of Medicine.
Treating an acute stroke is always a race against the clock, and the first step is to immediately determine, through the use of a CT or MRI brain scan, whether the stroke is a hemorrhagic stroke, caused by a burst blood vessel, or the much more common ischemic stroke, caused by a clot blocking the flow of blood in a blood vessel.
With an ischemic stroke, the clot-dissolving drug called tissue plasminogen activator, or tPA, is approved for use within three hours of the onset of stroke symptoms. But most stroke victims don't arrive at the hospital within that time frame, and even then, tPA may simply not work. Patients who don't respond to tPA then receive standard post-stroke care, or they may be considered for an embolectomy.
The MR RESCUE (Mechanical Retrieval and REcanalization of Stroke Clots Using Embolectomy) trial sought to determine if imaging the brain to see how much stroke damage has already occurred could identify which patients might be the best candidate for this procedure.
The trial, which began in 2004 and involved 22 sites in the U.S., included 118 patients (average age 65.5) who were treated within eight hours of experiencing an ischemic stroke. All the patients underwent a CT or MRI brain-imaging scan before treatment.
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UCLA-led study finds devices no better than meds in recovery from clot-caused strokes