According to recent research published in the September 2013 edition of Journal of Stroke and Cerebrovascular Diseases, patients see better results when they receive endovascular treatment at a dedicated stroke centre.
Matthew Berlet (interventional neuroradiologist), Glenn Stambo (interventional radiologist) and team from St Joseph’s Hospital, Tampa, USA, looked at 76 acute ischaemic stroke patients during a two-year period as part of a retrospective non-randomised study.
The patients were placed into five different treatment groups for acute ischaemic stroke. These groups included: group I (no treatment; n=24), group II (intravenous tissue plasminogen activator [IV tPA] only; n=18), group III (intra-arterial [IA] tPA; n=9), group IV (Mechanical embolus removal in cerebral ischaemia [MERCI]; retrieval only; n=17), and group V (combined [IA] tPA/MERCI; n=8).
The age range for all groups was 29–92 years and there were 39 women among the patients. The mean age for all patients was 70.1 years. The investigators obtained pre- and post-National Institutes of Health Stroke Scale (NIHSS) values for each group on arrival and discharge from the hospital. The results of the four treatment cohorts were compared with the no treatment group, providing the relative efficacy of these procedures compared with conservative medical therapy alone.
Berlet and Stambo discovered that patients treated with endovascular therapies at dedicated comprehensive stroke centres had fewer disabilities 90 days after a stroke than those treated with IV tPA, or those who received no treatment at all.
The researchers wrote in the Journal of Stroke and Cerebrovascular Diseasesthat there was a NIHSS reduction of 2.2 without treatment in group I; an NIHSS reduction of 7.1 in group II and reductions of 8.7, 12.8 and 5.1 for groups III, IV and V, respectively. Four patients died during hospital admission, two from group I (control group) and two from group V.
While IV tPA remains the most common and most readily available therapy to treat ischaemic strokes, the study suggests that endovascular stroke therapy administered at a dedicated stroke centre may have an impact on a patient’s quality of life compared with conservative traditional treatments.
The authors note that a more extensive, double-blind study would help define and elaborate this research, but this data may help educate the public about the necessity for continued advancement in stroke diagnosis and treatment.