An angiogram of a 48-year- old patient after treatment for a stroke. A blockage was targeted with clot-busting drugs using a catheter.
An angiogram of a 48-year- old patient after treatment for a stroke. A blockage was targeted with clot-busting drugs using a catheter.
It's another case of a beautiful idea colliding with some ugly facts.
The beautiful idea is the notion that clearing the blocked artery of a stroke patient with a device snaked right up to the blockage would salvage threatened brain cells and prevent a lot of disability.
A lot of stroke patients in the U.S. are already getting this endovascular (within-the-artery) treatment because the Food and Drug Administration approved the devices without clinical proof that they work. Medicare has begun paying for the treatment.
But now come those ugly facts. Three studies have now found no difference in outcome between patients who got the endovascular treatment along with an intravenous dose of a clot-busting drug called tPA, or Alteplase, and other patients who got only tPA.
"There wasn't really clear evidence that endovascular therapy added to tPA ... was better overall than tPA as the standard treatment," Dr. Joseph Broderick told MedPage Today. "It was hard to detect a signal of benefit in the studies that were presented."
Broderick, who led the largest of the three studies, was referring to disappointing results presented this week at the International Stroke Conference in Honolulu. He's research director of the neurological institute at the University of Cincinnati.
Stroke specialists will be chewing on the findings for months and perhaps years to come. But the first guess about why the artery-clearing devices didn't improve outcomes is that patients didn't get the treatments in time.
After all, the endovascular procedure can't be started until after intravenous tPA is tried first, and that can be as long as four-and-a-half hours after the first symptoms of stroke.
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Widely Used Stroke Treatment Doesn't Help Patients