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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