Treating Blood Clots at Source Aids Stroke Patients

A new study has offered the first evidence that treating brain blood clots at their source soon after symptoms begin can produce better outcomes than intravenous delivery of medication.

This kind of treatment, called intra-arterial (IA) delivery, involves first obtaining x-rays of the affected blood vessels, or angiograms, by introducing a contrast agent into the bloodstream. Once the blockage is identified, doctors insert a catheter in the leg that is guided through the neck to the brain and the site of the clot, where tissue plasminogen activator (tPA) is administered. In the study, 36 stroke patients received this treatment, with 50% having little or no neurologic disability afterward, compared to 39% of stroke patients who received intravenous (IV) tPA. In both cases, the drug was administered within three hours of the onset of symptoms.

The biggest advantage of IA delivery is that drugs delivered at the clot site are more likely to reopen the vessel than IV drugs. Partial or complete recanalization occurred in 75% of the patients treated with the IA therapy, compared to the 20-50% recanalization in most IV treatment trials.

"We also may use less of the drug, which may reduce the risk of hemorrhage, because we can watch the clot dissolve and stop administering the drug as soon as the vessel opens up,” said lead author Eric Bourekas, interventional neuroradiologist at Ohio State University Medical Center (Columbus, USA).