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A study coordinated by researchers from the
Hospital Clínic-IDIBAPS and published in the magazine
«JAMA» shows that the administration of a treatment after the intervention to trap the thrombus significantly improves the prognosis of patients. This method may represent a paradigm shift in the treatment of ischemic stroke throughout the world
Restoring circulation after an ischemic stroke is key to preserving the function of the affected area of the brain and ensuring that patients recover with the least possible sequelae.
The study involved 121 patients treated at tertiary stroke centers in Catalonia. One group of patients received fibrinolytic therapy (r-tPA) after mechanical thrombectomy and the other group received placebo after performing the same procedure.
Ángel Chamorro, head of the Cerebral Vascular Pathology Unit and of the research group Cerebrovascular diseases of
IDIBAPS has designed and coordinated the study and presents its results in the
International Stroke Conference en Nueva Orleans.
The mechanical thrombectomy It is a type of treatment that consists of the introduction of a catheter through the femoral artery through which a stent is advanced to the obstructed artery with the aim of capturing, between the stent meshes, the thrombus and extracting it after circulation . It is a highly complex procedure that is only performed in tertiary hospitals with highly qualified professionals.
“In 80% of cases we get the blood to circulate normally again, but we have observed that after three months the percentage of people who are completely free of sequelae is 27%” explains Ángel Chamorro. “We are much more effective at restoring normal circulation than the clinical efficacy we see,” he adds. This difference in percentages shows that the brain tissue close to the formation of the thrombus is going to die, even though the blood circulates with apparent normality again.
What is raised in the study is that, although the main artery is open, there is involvement at the level of the cerebral microcirculation. “This microcirculation is obstructed, it is as if we opened a highway, but we kept the exits closed” says Chamorro.
The microcirculation is below the diagnostic level of cerebral arteriography used to see the impact after mechanical thrombectomy. To restore it, the researchers considered administering a fibrinolytic drug, which enhances thrombus dissolution and helps restore blood flow after thrombectomy. “With this approach, we treat what we do not see but that we know is there”, explains the first author of the work and coordinator of the essay in the
Hospital Clínic It has been Arturo Renu.