A large EU-funded study with the participation of experts from Graz has now shown that the removal of the causative blood clot with a catheter intervention in severe strokes can save lives. "Even in patients with severe strokes, treatment using a catheter to open the vessel occlusion is successful. In almost 20 percent of the patients treated, death or the need for nursing care could be prevented by a corresponding procedure," the Hamburg University Hospital (UKE) now reported.
About 20 years ago, in the case of ischemic strokes (blood clots in a cerebral vessel), it was started to apply drug dissolution of these thrombi by medication. This in itself led to significantly better treatment results, because permanent damage can be prevented by the rapid restoration of oxygen supply to the brain. In recent years, catheter interventions for mechanical removal of the clot have been added with increasing frequency. The best results are achieved with all treatments if they are administered within four and a half or six hours of the onset of symptoms - in other words, as quickly as possible.
However, the development continues. "The TENSION study, funded by the European Union to the tune of six million euros, was conducted in 40 stroke centers in eight countries in Europe as well as in Canada. The treatment of patients with acute ischemic stroke (cerebral infarction) underlying a large vessel occlusion that had already led to a larger infarct core was investigated," the Hamburg-based hospital wrote. Hannes Deutschmann from MedUni Graz’s Clinical Department of Neuroradiology was also involved in the study as a co-author.
Major advantages of catheter treatment
Until now, catheter treatment of stroke patients has been carried out mainly on sufferers in whom little brain tissue had yet been damaged by the vascular occlusion. In addition, the time window for therapy was usually limited. In the study, however, treatment was also carried out up to twelve hours after the onset of symptoms.
In the study, patients were randomly assigned to either a group receiving standard conventional therapy (thrombolysis by drug, etc.) or additional catheter treatment. "In this so-called endovascular thrombectomy, doctors advance a catheter from the groin into the arteries of the brain under X-ray control to subsequently remove the blood clot that caused the vessel occlusion," the Hamburg University Hospital explained the procedure.
The first interim evaluation already showed major advantages of catheter treatment. In the course of evaluating the course of the disease in 253 patients after 90 days, significantly more of them were not dependent on permanent assistance after the stroke (two percent versus 17 percent); 31 percent were able to walk independently (versus 13 percent in the comparison group with drug treatment alone).
29 percent lower mortality
"The proportion of patients who died or required long-term care as a result of the stroke was nearly 20 percent lower in the group with catheter therapy (69 versus 87 percent), and the number of deaths was 11 percent lower (40 versus 51 percent)," the researchers reported.
"The results of the TENSION study show that catheter treatment is effective even in severe strokes. This treatment method can help the affected patients develop less consequential damage and lead a life with greater independence. On this basis, the standard therapy for severe strokes can be expanded and thus patient care can be improved," study coordinator Götz Thomalla, Director of the Department of Neurology at the UKE, was quoted as saying.
Because of the efficacy of endovascular thrombectomy in severe strokes thus demonstrated at an early stage, the study was terminated early after the first planned interim analysis. It was presented at the recent World Stroke Congress in Toronto and published in the medical journal "The Lancet". In Austria, around 25,000 people suffer a stroke every year.
Text Credit: APA Science 10/16/2023
