Endovascular Treatment Shows No Benefit to Patients With Extensive Stroke, Study Finds

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.

Endovascular Treatment Shows No Benefit to Patients With Extensive Stroke, Study Finds
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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

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