Skipping tingling IV and using mechanical clot removal alone for strokes can be as good as the combination of both treatments, with less risk of brain bleeding, according to the late science presented today at the American Stroke’s International Stroke Conference 2020 Association. conference, February 19-21 in Los Angeles, is a worldwide meeting for researchers and clinicians dedicated to the science of stroke and brain health.
The use of both therapies has previously been reported to improve outcomes in acute stroke patients with large vessel occlusion. However, blood clots could cause bleeding in the brain, and no studies have examined mechanical removal of the clot alone without alteplase, the most commonly administered IV clot destruction drug, within 4.5 hours.
In a Japanese, multicenter, prospective, randomized study, approximately 200 stroke patients (mean age 74; 62% men) were assigned to remove the mechanical clot alone or to combine a bust IV clot and mechanical clot removal. At 90 days, the favorable results, based on the level of disability, were similar: 59% for those who received only the removal of the clot and 57% for those who received the combined approach. There was no difference in the mortality rates between the two groups. However, brain hemorrhage rates within 36 hours were significantly lower for the mechanical clot removal group than for the combination treatment group (34% vs. 50%, respectively).
We believe that it is not necessary to administer alteplase to dissolve the clots and that mechanical removal of the clot can be performed immediately. If we skip alteplase, we can perform mechanical thrombectomy with low risk of bleeding. “
Kentaro Suzuki, M.D., Ph.D., professor in the neurology department at Nippon Medical School Hospital in Japan
Suzuki noted that five ongoing studies, including this study, are investigating the optimal approach for stroke patients.
“The current recommendations of the American Heart Association / American Stroke Association recommend using intravenous therapy within the 4.5 hour window and then dealing with mechanical removal of the clot, if appropriate,” said Mitchell SV Elkind, MD, MS, FAHA, FAAN, president-elect of the American Heart Association, former president of the American Stroke Association advisory board – a division of the American Heart Association and professor of neurology and epidemiology at Columbia University in New York and attending neurologist at the Columbia University Medical Center of New York- Presbyterian Hospital.
“The best strategy is usually to deal [alteplase] . . . and then if the patient is eligible, the patient also undergoes endovascular therapy, “said Elkind.” But [we] do not skip this initial step because endovascular therapy is sometimes delayed or does not occur for some reason. “
American Heart Association