Cerebral angioplasty and stent placement could prove advantageous to certain ischemic stroke patients, researchers from the Comprehensive Stroke Center at the University Hospital Ostrava in the Czech Republic have found.
"As many as 70 percent of ischemic stroke patients could have positive clinical outcomes with the additional use of intra-arterial revascularization using stents," said Martin Roubec, MD, PhD, a neurologist at the center, in a news release.
"Intravenous thrombolysis must be administered within four and a half hours of the onset of a stroke and cannot be used in patients who are taking anticoagulant medication," added David Školoudík, MD, PhD, associate professor at University Hospital Ostrava. "Because of these limitations, the majority of ischemic stroke patients receive no therapy at all."
Roubec, Školoudík and the rest of their team engaged 131 acute ischemic stroke patients — 74 men and 57 women with the mean age of 65.8 — over the course of two years. All participants had known obstruction in their middle cerebral artery. IVT treatment was administered to 75 patients, 35 percent of whom (26 patients) reached a favorable three month outcome. IVT was unsuccessful at re-opening the blocked artery for remaining 49 patients, thus either cerebral angioplasty/stent placement or no additional therapy was pursued.
For this segment of patients, the results were as such: “Of the 23 patients who underwent angioplasty and stenting, 10 (43.5 percent) achieved a favorable three-month outcome. Of the 26 patients who received no more therapy, four (15.4 percent) had a favorable outcome. The remaining two groups of patients were ineligible for IVT and received either revascularization treatment or received no further therapy. Of the 31 patients who underwent angioplasty and stent placement, 14 (45.2 percent) achieved a favorable outcome. Of the 25 patients who received no therapy, two (8 percent) had a favorable outcome.”
In cases of revascularization, physicians employed a digital subtraction angiography imaging technique to magnify the blood vessels and provide a guide wire passage to adhere to when steering a balloon-tipped catheter to the blockage location. A stent was placed in the aftermath of the ballooning process; patients who experienced a favorable three-month outcome at the procedure’s end were capable of functioning independently, the researchers were pleased to report.
"We demonstrated that in patients with middle cerebral artery blockage after IVT failure or for whom IVT is contraindicated, revascularization with stents is superior to providing no further therapy," Roubec concluded.