Intra-arterial revascularisation with stents safe and effective for stroke patients with contraindication for intravenous thrombolysis


Some stroke patients may benefit from cerebral angioplasty and stent placement, according to a new study published online ahead-of-print in the 11 December issue of the journal Radiology.

Martin Roubec, neurologist, Comprehensive Stroke Center, University Hospital Ostrava, Czech Republic and others set out to compare the safety and effectiveness of intra-arterial revascularisation using stents vs. no revascularisation in patients with contraindications to be treated with intravenous thrombolysis (IVT) or patients who failed to respond to IVT. Roubec stated: “As many as 70% of ischaemic stroke patients could have positive clinical outcomes with the additional use of intra-arterial revascularisation using stents.”

“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,” said study author, David Školoudík, associate professor at University Hospital Ostrava. “Because of these limitations, the majority of ischaemic stroke patients receive no therapy at all.”

The study involved 131 acute ischaemic stroke patients treated over a two-year period at two comprehensive stroke centres in Ostrava and Olomouc, Czech Republic. The patients, including 74 men and 57 women (mean age 65.8), all had a blockage in the middle cerebral artery detected by computed tomography (CT) or magnetic resonance imaging (MRI).

Seventy-five patients were treated with IVT; 26 (35%) of whom achieved a favorable three-month outcome. The remaining 49 patients, for whom IVT failed to re-open the blocked artery, received either cerebral angioplasty/stent placement or no additional therapy.

Of the 23 patients who underwent angioplasty and stenting, 10 (43.5%) achieved a favorable three-month outcome. Of the 26 patients who received no more therapy, four (15.4%) had a favorable outcome.

The remaining two groups of patients were ineligible for IVT and received either revascularisation treatment or received no further therapy. Of the 31 patients who underwent angioplasty and stent placement, 14 (45.2%) achieved a favorable outcome. Of the 25 patients who received no therapy, two (8%) had a favorable outcome.

To perform the intra-arterial revascularisation procedure, the physicians used an imaging technique called digital subtraction angiography to visualise the blood vessels and a guide wire to maneuver a balloon-tipped catheter to the location of the blockage in the middle cerebral artery. Once the balloon was inflated, deflated and withdrawn, a stent was inserted to help the artery remain open. Patients with a favorable three-month outcome following the procedure were able to live independently and perform normal daily activities.

Roubec concluded: “We demonstrated that in patients with middle cerebral artery blockage after IVT failure or for whom IVT is contraindicated, revascularisation with stents is superior to providing no further therapy.”