Stent placement ‘effective alternative to IVT in stroke patients’

Dec 31 2012

By Liam Davenport, medwireNews Reporter

In stroke patients in whom intravenous thrombolysis (IVT) is either contraindicated or has failed, intra-arterial revascularization with cerebral angioplasty and stent placement is an effective and well-tolerated treatment, say Czech researchers.

Lead investigator Martin Roubec, from University Hospital Ostrava, commented: "We demonstrated that in patients with middle cerebral artery after IVT failure or for whom IVT is contraindicated, revascularization with stents is superior to providing no further therapy."

He added: "As many as 70% of ischemic stroke patients could have positive clinical outcomes with the additional use of intra-arterial revascularizations using stents."

The team enrolled 131 patients with acute ischemic stroke due to middle cerebral artery occlusion detected on computed tomography or magnetic resonance imaging to take part in their study.

Of the participants, 75 underwent IVT, with 26 (35.5%) having a favorable outcome, defined as a modified Rankin Scale score of 0-2 at 3 months after stroke onset.

Among the remaining 49 patients for whom IVT failed, 23 received cerebral angioplasty and stent placement, while 26 had no additional therapy. At 3 months, 43.5% and 15.4% of these patients, respectively, had a favorable outcome.

A total of 56 patients were not eligible for IVT, of whom 31 underwent angioplasty and stent placement, while 25 received no therapy. Favorable outcome rates at 3 months for these patients were 45.2% and 8.0%, respectively.

Angioplasty plus stent placement was significantly more likely to achieve a favorable outcome at 3 months than no further therapy, the team notes. Furthermore, there was no significant difference in 3-month outcomes between patients with successful IVT and those who received cerebral angioplasty and a stent.

The results, published in Radiology, demonstrate that periprocedural complications occurred in one patient treated with cerebral angioplasty and stent after IVT failure and in one patient who received angioplasty and a stent because IVT was contradindicated.

Multivariate logistic regression analysis indicated that baseline National Institutes of Health Stroke Scale score was an independent negative predictor of good functional outcome, at an odds ratio (OR) of 0.85, and complete middle cerebral artery recanalization was an independent positive predictor, at an OR of 5.55.

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