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Michael E. DeBakey VA Medical Center - Houston, Texas

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VA Study Questions Assumptions Behind Wide-Spread Adoption Of Intra-Arterial Treatments For Stroke

June 22, 2007

HOUSTON – Researchers at the Michael E. DeBakey VA Medical Center (MEDVAMC) have found medical treatment for stroke seems overall to be just as effective as more invasive procedures using intra-arterial catheters. The review, by Pitchaiah Mandava, M.D., Ph.D., M.S.E.E., Neurology Care Line staff physician and Thomas Kent, M.D., Neurology Care Line executive, appeared in the June 12, 2007 issue of Neurology.

Stroke is the number one cause of adult disability in the United States and the third leading cause of death. More than 700,000 people experience a new or recurrent stroke each year. Every 45 seconds an American has a stroke, every three minutes someone dies of a stroke in this country, and 15-30 percent of stroke survivors have serious long-term disability. The Department of Veterans Affairs (VA) estimates it hospitalizes 15,000 veterans with a stroke each year.

One medical treatment option for stroke is a medication called tissue plasminogen activator (tPA). This is a “clot- busting” drug shown to be helpful in treating ischemic strokes caused by blood clots, but it must be given within the first three hours after the start of symptoms. While tPA can significantly reduce the effects of stroke and reduce permanent disability, most stroke patients do not arrive in time to receive the medication.

A more invasive option is intra-arterial (IA) therapy where arterial catheters are used to remove the clot causing the stroke. Using x-ray guidance, an interventional radiologist inserts a catheter through a nick in the skin at the groin and advances it through the femoral artery in the leg all the way to the tiny arteries in the brain where a clot-busting drug is placed directly on the clot or used to break up the clot mechanically.

“Since there are no randomized trials comparing IA therapies with best medical treatment, we compared outcomes with models of outcome. While some studies did better than natural history of stroke, there was a lack of evidence for a net improvement in outcome after IA therapy relative to predicted natural history, substantiating the need for a prospective comparison with best medical therapy." said Mandava. 

"Our additional analysis suggested that until these comparison studies are performed, IA therapy, if used, should be reserved for more severe patients who will do poorly without intervention," said Kent.

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