In patients who have suffered a stroke and a major infarction, thrombectomy combined with medical care provides better functional results and reduces mortality.
- Healthcare-related thrombectomy reduces the “absolute risk of death by 20%” in patients with acute stroke and major heart attack.
- This association also led to a functional improvement “bringing one in 5 patients home after 6 months of rehabilitation”.
- However, it resulted in a higher incidence of symptomatic intracerebral hemorrhage.
When a blood clot blocks a large intracranial artery, a thrombectomy should be performed within 6 hours of the stroke. This radiological intervention aims to unblock the cerebral artery responsible for the infarction in order to restore blood circulation. But, “the use of thrombectomy in patients with acute stroke and large infarction has not been well studied,” according to neurologists and neuroradiologists at Gui de Chauliac Hospital in Montpellier (France).
Stroke: a lower score on the Rankin scale which assesses the disability of patients
This is why they decided to conduct a study, published in the journal New England Journal of Medicine, to determine how to improve the chances of survival of stroke patients. As part of the work, the team recruited 333 people with occlusion of a proximal cerebral vessel in the anterior circulation and a large infarct detected on magnetic resonance imaging (MRI) or CT scan within 6.5 hours following the onset of symptoms. For research purposes, 166 participants were assigned to undergo endovascular thrombectomy and medical care. The rest of the volunteers received only medical treatment.
Due to similar trial results favoring thrombectomy, the trial was terminated prematurely. The authors found that about 35% of patients received treatment with thrombolysis (an injection of a drug intended to dissolve the clot). The median score on the modified Rankin scale (which makes it possible to assess the disability of patients in the acute phase of post-stroke recovery) at 90 days was 4 in the group having received endovascular thrombectomy and 6 in the group. control group.
Thrombectomy is linked to “functional improvement after 6 months of rehabilitation”
“To the great surprise of the entire international medical scientific community, the therapeutic trial proved very strongly positive with a reduction in the absolute risk of death of 20% and a surprising functional improvement bringing home one in every patient. 5 after 6 months of rehabilitation”can we read in the press release from Montpellier University Hospital. In contrast, the percentage of patients with symptomatic intracerebral hemorrhage was 9.6 and 5.7%, respectively. Eleven procedure-related complications were reported in the thrombectomy group.
“We are very proud of our teams but also of having been able to bring together almost all French university hospitals on this initiative, resulting in a change in medical practice around the world. The IN EXTREMIS study continues to develop in Spain, but also in the United States, to continue to push the limits of current indications for treatment by mechanical revascularization of stroke”, declared Vincent Costalat and Caroline Arquizan, doctors and authors of the work.
