-- Robert Preidt
TUESDAY, Dec. 11 (HealthDay News) -- Certain stroke patients
might benefit from angioplasty and the placement of artery-opening
stents in brain blood vessels, a new study suggests.
The finding focuses on ischemic strokes -- attacks that occur
when blood flow in the brain in blocked, often by a blood clot or
fatty deposit. In brain angioplasty, a balloon-tipped catheter is
guided to the area of the blockage and the balloon is inflated in
order to open the blocked blood vessel. Once the balloon is
deflated and withdrawn, a tiny mesh tube called a stent is inserted
to help the vessel remain open.
This study included 131 ischemic stroke patients, averaging
about 66 years of age, in the Czech Republic. All had suffered a
middle cerebral artery blockage. Seventy-five of the patients
received a clot-busting drug while the rest were not eligible for
such drugs, which must be given within four-and-a-half hours of
stroke onset and cannot be given to patients taking blood-thinning
Due to these types of limitations, many ischemic stroke patients
receive no treatment at all, said researcher Dr. Martin Roubec, a
neurologist at the University Hospital Ostrava in the Czech
Republic, and colleagues.
Of the patients in the study who received a clot-busting drug,
35 percent had a favorable outcome three months after their stroke.
Among the patients in which the clot-busting drug failed to re-open
the blocked artery, just less than half underwent brain
angioplasty/stent replacement while the rest received no additional
Of the patients who underwent angioplasty/stenting, nearly half
had a favorable three-month outcome, compared to just 15 percent of
the patients who received no further treatment.
Among the patients who did not receive a clot-busting drug, 31
underwent angioplasty/stenting and 25 received no further
treatment. Favorable outcomes were reported in 45 percent of those
who underwent angioplasty/stenting and in 8 percent of those who
received no further treatment.
The study was published online Dec. 11 in the journal
For patients with this type of arterial blockage who cannot
receive clot-busting drugs or do not benefit from them, re-opening
the vessel "with stents is superior to providing no further
therapy," Roubec said in a journal press release.
Two experts in the United States stressed that the usefulness of
this approach is still being debated.
Dr. Keith Siller is medical director of the Comprehensive Stroke
Care Center at NYU Langone Medical Center in New York City. He
noted that although the Czech trial found a real benefit for
patients with ischemic stroke, another trial (known by the acronym
SAMMPRIS), "concluded that patients with recent stroke and
[mini-strokes] from longstanding blockages in brain arteries had
worseoutcomes with angioplasty and stenting compared to
using standard medications (aspirin, clopidogrel, statin) combined
with aggressive risk-factor modification (exercise, diet,
However, Siller -- who is also assistant professor at the NYU
School of Medicine -- said the Czech trial used similar stents but
focused on "a slightly different" and less easily managed subset of
patients who "are known to have the worst outcomes if their
arteries remain blocked."
He believes that for these patients, "Roubec's report clearly
shows that in experienced hands, angioplasty and stenting led to
better clinical outcomes and less hemorrhagic complications with
results that were superior to the patients in SAMMPRIS."
The bottom line, for Siller: Angioplasty plus stenting may have
a role for these worst-case patients, but the approach is "still
unproven in less urgent scenarios where the goal is preventing
recurrence in the near future."
Another expert agreed.
"Based on the study, stenting in the acute stroke setting may be an option for patients that have contraindications for [clot-busting drugs]," said Dr. Rafael Ortiz, director of the Center for Stroke and Neuro-Endovascular Surgery at Lenox Hill Hospital in New York City. "Further prospective information about stenting in the acute stroke setting is necessary to make final recommendations about the safety and efficacy of this therapy."
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