Health
Does “Bridged” Therapy Improve Outcomes in Stroke Patients? Meta-analysis found that thrombus-destroying drugs and subsequent thrombectomy were most effective-ScienceDaily
There has been debate about the best treatment for certain types of stroke caused by obstruction of the aorta in the brain. In a new meta-analysis, people with this type of stroke who can be treated within four and a half hours after the onset of symptoms are better off after the stroke when treated with both thrombectomy and physical thrombectomy. It turns out that there is a possibility of going, compared to physical removal only. This survey was published in the online version on February 16, 2022. Neurology®, American Academy of Neurology Medical Journal. The combination of the two therapies, called bridging therapies, has helped increase the likelihood of people living independently after a stroke.
The most common type of stroke is an ischemic stroke that occurs when the blood vessels that supply blood to the brain are blocked. If the obstruction is in the major artery, it is called a large vessel occlusion stroke. The precirculatory macrovascular occlusion examined in this study occurs in the anterior part of the brain and is a major cause of disability in adults.
Two-step bridge therapy includes: Intravenous thrombolytic therapy, injection of thrombolytic drug. Mechanical thrombectomy is a minimally invasive procedure that removes a thrombus with a small incision.
“For people with this type of stroke, our analysis shows that when thrombus-destroying drug therapy is used in combination with physical removal, it is more than treating people with only physical removal of blood clots. It suggests that good results may be obtained, “said Gabriella Trifan, author of the meta-analysis. She is an MD at the University of Illinois at Chicago and a member of the American Academy of Neurology. She found that bridging therapy was also associated with increased potential for stronger blood flow to return to the post-stroke brain, and thus to improved functional independence in post-stroke people. “
For a meta-analysis, the researchers examined 41 studies of 14,885 large vascular occlusion strokes with an average age of 70 years. Of these, 8,238 were treated with bridge therapy and 6,647 were treated with thrombectomy alone. The drug alteplase was used for thrombus-destroying therapy.
Researchers have found that people who receive bridge therapy are 29% more likely to live independently after three months. Trifan states that this is expected to add 62 people for every 1,000 people and can live independently on bridge therapy as well as thrombectomy. People who received bridge therapy also had 24% higher odds of blood flow back to the stroke-affected part of the brain compared to those who did only thrombectomy, with an additional 34 for every 1,000 people. It was expected.
People who received bridge therapy were also 31% less likely to die 90 days after a stroke than those who had only thrombectomy. Trifan said this meant that 59 deaths were expected per 1,000 people.
When researchers limited the analysis to the latest six high-quality randomized clinical trials, they found that the results of functional independence and safety were similar between treatment and clot removal only. discovered. “These results are not powerful enough to change practice at this time, but thrombectomy can be as efficient and safe as bridge therapy for selected patients with appropriate clinical settings, a personalized medicine concept. It constitutes a step towards, “said Trifan.
Meta-analyses have not proven to give better results when people with this type of stroke are treated with both treatments. Only associations are displayed.
“This meta-analysis shows that bridge therapy is safe and does not increase the risk of bleeding or delay the initiation of thrombectomy,” Trifan said.
The limitation of the meta-analysis is that alteplase was the only drug approved in this analysis. In addition, the results apply only to people who go to a medical center that offers thrombectomy.
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material Provided by American Academy of Neurology.. Note: Content can be edited in style and length.
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