Updated 27 January 2015

Stents are best for removing stroke-causing blood clots

Using a stent to capture and remove a stroke-causing blood clot is safe and improves recovery with only slight disability.


Using a stent to capture and remove a stroke-causing blood clot is safe and improves recovery, Dutch researchers report.

About one-third of patients who had the procedure – called intra-arterial treatment – recovered from their stroke with only slight disability and were able to care for themselves, compared with just 19 percent of patients given regular care, the researchers found.

"We knew already that we can open up blocked vessels with the treatment, but now we have proof that patients have better outcomes, they actually benefit by being less disabled and less handicapped," said lead researcher Dr. Diederik Dippel, a neurologist at Erasmus M.C. University Medical Centre in Rotterdam.

Dippel stressed that to be effective this treatment must be done in the first six hours after stroke symptoms start. And, the sooner the better.

Read: Heart bypass surgery or stents?

Unlike stents used to open blocked heart arteries, which are left in place to keep the artery open, stents used in intra-arterial treatment are removed, Dippel said.

During intra-arterial treatment, a stent – a tiny wire mesh sleeve – is attached to a catheter and threaded through the artery blocked by the blood clot. The stent is expanded so it covers the clot, trapping it. Once the clot is enclosed in the stent, the stent is removed along with the clot, he explained.

Procedures such as this one always carry risks, but in this case the trial showed that the risks were outweighed by the benefits, Dippel said.

The results of the trial, largely funded by the Dutch Heart Foundation, were published in the New England Journal of Medicine.

Managing stroke

For the trial, researchers randomly assigned 500 stroke patients to intra-arterial treatment or regular care. One hundred and ninety ended up receiving intra-arterial treatment. And almost 270 were given regular care, according to the study. The average age of the patients was 65 years.

Among all the patients, most (89 percent) were treated with the clot-busting drug alteplase (tPA) before starting other treatment.

According to Dippel, however, the use of tPA is not essential for good outcomes from intra-arterial treatment. Those patients who did not receive the drug before intra-arterial treatment fared as well as those who did, he said.

"This trial is a game changer for the management of stroke," said Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine. Sacco noted that earlier trials using the procedure were disappointing.

Read: Brain stents for some stroke patients

Currently, intra-arterial treatment is not widely used in the United States. Sacco believes that these results might increase its use, especially in special stroke centres for selected patients.

"[This study] shows impressive clinical results among patients treated quickly compared to usual care," Sacco said. "This trial provides more convincing evidence for this approach that can now be offered to more of our stroke patients at comprehensive stroke centres."

Sacco added that the procedure likely costs around $35 000. But it may be cost effective, considering the cost of treating the disabilities it prevents, he noted.

Stroke is the fourth leading cause of death in America and a leading cause of adult disability, according to the American Stroke Association.

Read more:
Vascular stenting
Biodegradable coronary stents show long-term safety
Stents no better than medicine

Image: Stent angioplasty from Shutterstock

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