Is endovascular therapy a breakthrough in stroke treatment?

This study investigated whether a procedure called endovascular thrombectomy, which is a minimally invasive surgery to remove a blood clot, plus drug therapy is better at restoring blood flow and improving outcomes in patients with ischemic stroke, compared to drug therapy alone.

A stroke occurs when there is a disturbance of blood supply to a part of the brain. This can be caused by a blood clot in the brain (ischemic stroke) or a burst blood vessel (hemorrhagic stroke). Both types of stroke result in a lack of oxygen and food reaching the brain tissue and can cause brain damage.

Treatment for ischemic stroke requires drugs that break up the blood clot (thrombolytics) and restore blood flow to the brain region. New ways are being tested that enhance the treatment of stroke such as endovascular thrombectomy surgery.

Endovascular thrombectomy is the removal of a blood clot (thrombus meaning blood clot) by inserting a small flexible tube, called a catheter, into a blood vessel. The catheter is usually inserted in the groin area and moved along the blood system until it reaches the blood clot. The catheter then captures the blood clot and draws it out of the body.

This study investigated whether endovascular thrombectomy plus traditional thrombolytic drug therapy improved outcomes for patients with ischemic stroke, compared to thrombolytic therapy alone. All 70 patients, with an average age 70 years, had salvageable (rescuable) brain tissue as measured by computed tomography (CT) scans, in comparison to large irreversible areas of low oxygen (ischemia). All patients received thrombolytic therapy (e.g. altplase [Activase]) within 4.5 hours of stroke onset, and when assigned, received endovascular thrombectomy within 6 hours of stroke onset.

The study found that patients who received endovascular therapy with drug therapy demonstrated a significant increase in the restoration of blood flow within 24 hours, and significant increased neurological improvement (e.g. improved consciousness, eye movement, sensory and motor function, language and speech, and alertness) within 3 days, compared to those who received drug therapy alone.

Overall, 70% of patients who received endovascular thrombectomy had a lower degree of disability and achieved functional independence (did not require carers) 90 days after stroke, compared to only 40% of patients who received thrombolytic therapy alone. There was no significant difference in mortality rate between the two groups, suggesting that the surgery is safe with a low rate of complications.

The study concluded that endovascular thrombectomy plus thrombolytic therapy significantly improves patient outcome, compared to thrombolytic therapy alone, in patients with ischemic stroke and rescuable brain tissue. 

The study was stopped early due to the superiority of endovascular thrombectomy plus thrombolytic therapy. However, this means that the study ended up having a smaller study population and shorter study period and introduces the possibility that the superior effect of endovascular thrombectomy was overestimated too early in the trial. 

Talk to a doctor about the health benefits of receiving endovascular thrombectomy plus drug therapy after the onset of stroke.