Endovascular therapy is a type of stroke treatment for emergencies. This is a type of interventional medicine, which means that this treatment is in the form of a medical procedure, not a pill or an intravenous treatment.
What are the common treatment methods for stroke?
So far, the most common emergency treatment for stroke is TPA, which was established about 20 years ago. TPA is a drug called a tissue plasminogen activator, a strong blood thinner that is injected into a vein, usually in the arm.
The drug quickly travels to the brain where it works by dissolving the blood clot that causes an ischemic stroke.
A newer, stronger type of stroke therapy is called intra-arterial thrombolysis, a type of interventional endovascular procedure used to prevent strokes from forming new blood clots.
What is meant by endovascular therapy?
Endovascular therapy is a type of procedure that involves placing a tube called a catheter into a blood vessel. The purpose of intra-arterial therapy is to place a catheter into an artery, that is, a blood vessel blocked by a stroke. Meanwhile, thrombolysis is the process of destroying blood clots.
What is intra-arterial thrombolysis?
Intra-arterial thrombolysis procedures to treat stroke must be done very quickly, usually within 6-12 hours after the initial stroke symptoms appear. In general, intra-arterial thrombolysis requires an initial scan study, such as an MRI / MRA of the brain to determine the location of the blood clots.
Then, the catheter is inserted into an artery, such as in the arm or groin. The catheter contains a strong blood thinning drug called alteplase. The catheter is then carefully and progressively infiltrated all the way to the blocked brain artery until it reaches a blood clot. Instantly the blood thinner will dissolve the existing blood clots.
Experienced physicians must perform this complex procedure and its preparation involving a team of neurologists, radiologists and possibly surgeons.
What is MR CLEAN?
The Dutch Heart Foundation and other organizations are helping to fund a new research trial called MR CLEAN in the Netherlands. This study aims to evaluate the effectiveness and safety of the intra-arterial thrombolysis method for the treatment of stroke. The results of the trial, published in January 2015 by the New England Journal of Medicine, involved 500 stroke patients from 16 medical centers in the Netherlands.
Of the 500 stroke patients, 233 of them underwent intra-arterial thrombolysis and 267 underwent regular stroke treatment. The results showed that patients undergoing thrombolysis had better functional outcomes with a modified Rankin score benchmark — a scoring system that refers to a person's independence after stroke. The intra-arterial thrombolysis group did not experience more side effects than the non-thrombolysis group.
What is the importance of this treatment for me?
If you have had a stroke, intra-arterial thrombolysis is the only option if you arrive at the hospital a few hours after the initial stroke symptoms appear. There are strict rules regarding the intra-arterial thrombolysis procedure for safety reasons. If you are eligible for intra-arterial thrombolysis, you or a family member must give consent for the procedure. However, there is not much time for hesitation in decision-making because when that limited time span has passed, the treatment is no longer effective and is likely to be even more dangerous.
If you have had intra-arterial thrombolysis, it will definitely take you some time to heal. Some patients recover completely without experiencing side effects, while others experience minor side effects from stroke.
