Thrombolysis still best treatment for acute stroke
02 October 2019
Recent research from George Clinical has analyzed both thrombolysis and neurointervention treatments and determined that thrombolysis is still the best treatment for acute stroke patients. The recent revolution in neurointerventional clot retrieval has prompted this study to evaluate stroke treatments and determine if thrombolysis can be made safer for patients. Since thrombolysis has limitations of bleeding risk, the study aims to analyze what can be done to complement or act as an adjuvant to thrombolysis.
Neurointervention is a word used to describe a treatment approach to conditions that occur within the vessels of the brain or within the spinal cavity. Utilized in place of more invasive procedures which require opening the skull or exposing the spinal column, neurointerventional procedures are minimally invasive, meaning they can be accomplished through tiny incisions no bigger than the size of a nickel. Neurointervention treatment for stroke has been proven to be a highly effective treatment in a sub-population of ischemic stroke sufferers in relation to a large occlusion of a proximal intracerebral vessel – the ‘reperfusion responder’. Overall, about 80% of all strokes are ischemic (caused by a blockages of a blood vessel in the brain), and those with large clots and residual viable brain tissue, the ‘reperfusion responders’, comprise 15% of this group. Since only a small population of stroke patients can benefit from neurointervention, thrombolysis remains the primary treatment.
Thrombolysis is the breakdown of blood clots formed in blood vessels, using medication. It is used in ST elevation myocardial infarction, stroke, and very large pulmonary embolisms. It is also known as thrombolytic therapy. Its core aims to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs. Thrombolytic treatment, and more specifically recombinant tissue plasminogen activator (rtPA), is the only approved treatment for ischemic stroke, it is estimated that only 4-5% of patients receive this therapy in Australia. In good centers, this figure may reach 20% but still this is nowhere near enough. The brain deteriorates rapidly at the onset of stroke. In order to be eligible for thrombolysis, the patient needs to have sufficient salvageable tissue when they are presented to hospital. This time window is estimated to be only 3 to 4.5 hours in most patients, with patients on the latter end of this scale being eligible if they meet a number of pathophysiological criteria based on their imaging results. There are also significant limitations to rtPA – it sometimes does not achieve rapid reperfusion and has relatively low recanalization rates. It also increased the risk of major hemorrhage within the brain and early death. Because of the need for quick treatment, the study calls for pursuing improved healthcare delivery services and finding therapeutic strategies that will increase the number of eligible patients for thrombolysis taking into account the health care delivery factors between the onset of a stroke and treatment including detection, ambulance time, triage, etc.
Published by Pharma-iq.com on September 10, 2019
Image by Shutterstock