A study has discovered that endovascular treatment or EVT shows no benefit to patients with extensive stroke and may even contribute to an elevated risk of hemorrhage and mortality, with the elderly people being at the highest risk.
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What Is Endovascular Treatment?
Endovascular treatment is a non-surgical treatments for
the sudden loss of brain function due to blood clotting. This minimally
invasive procedure is done inside blood vessels and can be utilized to treat peripheral
arterial disease or PAD – which is a common type of vascular problem in the aorta,
carotid or legs.
The treatment utilizes microcatheters – thin tubes
visible under X-rays, which are inserted into the blood clot from the groin or
the arm. Blood clot is removed from the blood vessel, this procedure is called
thrombectomy. In cases where the blood clot cannot be removed, this needs to be
liquefied using drugs delivered through the catheter in a procedure called thrombolysis.
How Does Thrombectomy Work?
A catheter will be inserted into an artery in your arm
or groin, by the interventional radiologist, and move it towards the blood clot
under X-ray guidance. Blood clot is removed in a procedure called a thrombectomy.
Blood clot may be removed by trapping it in a stent which is then pulled out
with the clot or it will suck the clot out through the catheter.
A medication will be applied through the catheter, if
the blood clot cannot be removed, in order to liquefy it. On the other hand, a
balloon catheter will be used to restore the original size of the blood vessel
if ever the blood vessel is too narrow, and this procedure is called an
angioplasty. Subsequently, a stent is inserted to hold the blood vessel open.
Based on a retrospective study covering 248 patients
with extensive baseline infarctions (Alberta Stroke Program Early Computed
Tomography Score <5) attributed to anterior circulation stroke. Half
of the population underwent EVT while the other half of the group received best
medical treatment.
Primary functional endpoints were rates of good (modified
Rankin Scale score of <3) and very poor outcome (modified Rankin
Scale score of ≥5) at 90 days. Symptomatic intracerebral hemorrhage was assigned
as the secondary safety endpoint.
With the analysis, there was no significant difference
in the number of patients who attained good functional outcome in the EVT and
best medical treatment group. The factors independently correlated with very
poor results were advanced age and symptomatic intracerebral hemorrhage.
Regarding secondary results, patients in the EVT vs best
medical treatment group had higher mortality (43.5% vs 28.9%) and developed symptomatic
intracerebral hemorrhage more frequently (16.1% vs 5.6%).
Lowest rates of good functional results were observed
among patients with failed and partial recanalization, which is a modified
thrombolysis in cerebral infarction scale score of 0/1-2a. However, patients
with complete recanalization (modified thrombolysis in cerebral infarction
scale score of 3) with recanalization attempts <2 benefitted the most
with EVT (modified Rankin Scale score of <3).
Source: Stroke 2021;doi:10.1161/STROKEAHA.120.033101