Treatment of Stroke: Endovascular Treatment Versus Intravenous Thrombolysis

Stroke arises due to sudden obstruction in blood flow to a part of the brain. The obstruction is often due to a clot in important blood vessels. The treatment in such cases is to break the clot with medications and allow the free flow of blood. This has often been achieved by injecting drugs like recombinant tissue plasminogen activator (t-PA) into the veins, through which it goes to the site of obstruction and breaks the clot. Intravenous therapy (injecting the drug through the vein) has been associated with side effects like bleeding. In addition, it has to be administered within 3 to 4.5 hours of the stroke. Therefore, endovascular revascularization techniques have been adopted in the recent years to overcome some of the difficulties of intravenous treatment. These techniques deliver the drug at the site of the block and therefore prevent widespread bleeding. They are also effective even after 3 hours following a stroke and therefore can be used when the patient reaches the hospital a little late.

But is endovascular revascularization more effective than intravenous treatment? Maybe not, according to a recent study published in the New England Journal of Medicine.

The study was conducted on 362 stroke patients between the ages of 18 and 80 years undergoing either of the procedures. The study found that endovascular treatment was not superior to intravenous t-PA in terms of being alive without disability at the end of three months. The incidence of side effects, especially with respect to bleeding within the brain, was similar in the two groups.

The study thus concluded that based on the outcomes, both the procedures are similar and it is not possible to proclaim one superior over the other.

Thus, it is not necessary to prefer endovascular procedures which are more expensive and require more expertise to the conventional intravenous treatments. However, the researchers do not deny that it is possible that newer devices used for endovascular treatment could provide added benefits.

Reference:

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1. Endovascular Treatment for Acute Ischemic Stroke; Alfonso Ciccone, et al; NEJM 2013

Source-Medindia