A paper by Albers et al published in the NEJM suggests that many more stroke victims can be saved from
disability or death if they undergo removal of thrombi obstructing their
internal carotid or proximal middle cerebral artery.
182 stroke patients
with clots in major vessels were enrolled in the study. They were last known to be well between 6 and
16 hours earlier and had diffusion and perfusion MRI scans upon admission to
Emergency Room. Patients with proximal middle-cerebral-artery or
internal-carotid-artery occlusion, and an initial infarct size of less than 70
ml, and a ratio of the volume of ischemic tissue on perfusion imaging to
infarct volume of 1.8 or more were randomly assigned to endovascular therapy plus
standard medical therapy or standard medical therapy alone. The primary outcome
was the score on the modified Rankin scale (range, 0 to 6, with higher scores
indicating greater disability) at day 90.
Ninety-two of these patients had clots
removed, while the remaining 90 did not.
The study found that the 90-day death rate was lower for
patients who had a thrombectomy vs. those who did not – 14 percent vs. 26
percent. The data also indicated that more pronounced
was the rate of functional independence among the thrombectomy patients – 45
percent vs. 17 percent at 90 days after the procedure.
Endovascular thrombectomy for ischemic stroke plus standard
medical therapy resulted in better functional outcomes than standard medical
therapy alone among patients with proximal middle-cerebral-artery or
internal-carotid-artery occlusion and a region of tissue that was ischemic but
not yet infarcted.
