Thrombectomy is what many in the stroke community call the ‘miracle treatment’ for stroke, with some patients being able to walk out of the hospital the day after receiving the treatment.
Thrombectomy is commonly used to remove blood clots from brain arteries, offering a quick and effective way of removing a stroke causing blood clot in the large arteries that supply blood to the brain.
When performed in ample time, thrombectomy has shown to have more beneficiary effects than clot-busting drugs such as thrombolysis.
Recent technological advances have made it possible for thrombectomy to be preformed in some of the narrower vessels in the head, such as the anterior cerebral arteries that arise from the internal carotid artery.
However, evidence supporting any potential benefits of thrombectomy for these vessels remains unknown.
As part of the Treatment for Primary Medium Vessel Occlusion Stroke, also known as the TOPMOST trial, researchers in Germany compared thrombectomy with medical treatment in 154 patients.
The patients all had primary isolated anterior cerebral artery medium vessel occlusions, or obstructions. The patients underwent thrombectomy or the best available medical treatment, which typically involves medications to dissolve the clot and reduce blood pressure. In some cases, patients may receive intravenous thrombolysis, the introduction of clot-busting drugs to the bloodstream or directly to the site of the clot.
Researchers assessed early outcome, or outcome within the first 24 hours after treatment, and longer-term functional outcome. They also examined safety with a focus on bleeding in the brain and death.
The results showed that thrombectomy was a safe and technically feasible option.
Within the first 24 hours after treatment, thrombectomy patients had similar outcomes to those who received best medical treatment alone with or without intravenous thrombolysis.
Longer term, both groups had similar clinical and functional outcomes. Mortality rates were similar in both groups.
Study lead author, Dr Lukas Meyer, says: “Based on our study, both treatment options appear to be effective and safe.
“The overall results of the study are consistent with a growing body of literature suggesting that thrombectomy may have a role in the treatment of this type of stroke. Eligible patients should therefore be randomised to ongoing prospective trials whenever possible.”
Dr Meyer also highlights that the type of blockages his team studied are rare, and all the centres involved in this study were tertiary stroke centres with a high level or expertise in these kinds of interventions.
He continues by noting that the selection of patients for thrombectomy remains a key issue, especially when patients are not eligible for randomisation in a designed trial.
Dr Meyer, says: “As we anticipate an increasing number of patients with medium vessel occlusions being treated with thrombectomy, age and eloquence of symptoms in particular are factors that should be considered when making treatment decisions.
“Ultimately, the results of ongoing randomised trials will provide further insight into this subgroup.”
Dr. Meyer plans to conduct further analysis of a subgroup of these patients to gain a deeper understanding of procedural and clinical outcomes. He also wants to identify potential surrogate markers that can predict clinical course.
