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The newspaper of The Johns Hopkins University December 1, 2003 | Vol. 33 No. 13
Stents Combined with Clot-busting Drugs Limit Impact of Deadly Form of Stroke

By Gary Stephenson
Johns Hopkins Medicine

A small but promising study suggests that coupling the insertion of stents with injections of clot-busting tissue plasminogen activator, known as tPA, directly into blocked blood vessels that serve the brain is an effective way to either prevent or limit the damage from acute vertebrobasilar ischemic stroke, according to a team from Johns Hopkins.

The study's results, reported in the October issue of The American Journal of Neuroradiology, assessed the clinical outcomes of six consecutive patients treated at Johns Hopkins with both the vessel-opening stents and tPA at variable times after the onset of the stroke.

Four of the six patients experienced immediate improvement of neurologic symptoms, which have continued permanently after treatment. The two other patients, who were both critically ill at the time of the treatments, subsequently died because their blood clots failed to respond to the tPA treatment due to the large size of the clots and the length of time they were in place before treatment began.

Acute vertebrobasilar ischemic strokes, caused by clots in the major arteries located in the skull behind the upper and lower jaw, respectively, are often fatal or the cause of severe brain damage.

The usual treatment consists of injecting anticoagulants, such as tPA, to dissolve the clot and prevent further growth or new clots, but the risk of recurrent stroke or stroke damage remains high, according to Kieran Murphy, director of interventional neuroradiology at Johns Hopkins and principal investigator for the study. "Without treatment, as many as 90 percent of these patients will die," he added.

The new study does not directly compare the drug-only conventional treatment with the combined approach, although Murphy said it suggests the possibility that the combination treatment offers a superior option for most patients.

For now, however, Murphy and his colleagues are planning a longer follow-up study of the four surviving patients, as well as other similar patients they will treat as part of a larger study they will conduct using the combined approach.


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