The Hospital Clínic de Barcelona has shown that a change in the timing of administering a treatment that is already used to treat ischemic stroke increases the chances of the patient obtaining an excellent recovery and without sequelae three months after the procedure by up to 59%. .
This marks a before and after stroke treatment”, highlighted the Head of the Cerebral Vascular Pathology Unit of the Clínic, Ángel Chamorro, coordinator of the CHOICE study with results on the sequelae, which has been presented at the International Stroke Conference in New Orleans (United States) and has been published in the journal «JAMA».
Ischemic stroke, which represents 85% of all embolisms, is caused by the obstruction of a cerebral blood vessel and causes 6 million deaths each year in the world, being the second leading cause of death.
If it does not kill, the stroke can leave important consequences for life -in fact it is the first medical cause of disability in the world-, even in those patients who, mechanically, manage to extract the thrombus from the blood.
an intravenous drug
In the first 24 hours after the appearance of the stroke, the treatment consists of administering an intravenous drug, alteplase; and performing a mechanical thrombectomy, which consists of inserting a catheter through the artery until it reaches the thrombus, in order to extract it.
In 85% of cases it is possible to remove the thrombus and restore blood circulation in the brain, but this is not always a guarantee of complete recovery, since after 3 months many patients present sequelae or some type of disability.
The researchers of clinic and the August Pi i Sunyer Biomedical Research Institute (Idibaps) suspected that the problem could be that there was thrombosis in the capillary vessels, the “peripheral roads” of the bloodstream network, which can become as fine as a hair and of which it is not possible to have images.
Thus arose the CHOICE projectwhose objective was to test whether the same drug that is given in the first hours of the stroke, alteplase, could help reduce possible damage to the capillaries if administered after thrombectomy to remove the thrombus.
The study, financed with funds from the TV3 Marathon, had 121 participants, randomly divided into two groups: one was administered the drug after removing the thrombus and the second, placebo.
The results of the CHOICE project
The results have demonstrated the efficacy of this change in treatment: in the placebo group, 40% of the patients remained without sequelae and with independent life, without disability, while among those who received the drug after thrombectomy the percentage it rose to 59%, a difference therefore of 19% between the two groups.
The advantage of this study is that the drug is already available in hospitals, so as of this Thursday there will be “many professionals in the world who will begin to do it,” Dr. Chamorro ventured.
In any case, for the most “skeptical”, he has considered that a second study will be necessary with a more “robust” sample of patients so that the new procedure is validated and can be included in the clinical guidelines, a process that could be completed between this year and the next, he estimated.
For its part, the neurologist at Clínic-IDIBAPS and coordinator of the clinical trial, Arturo Renú, has specified that, although they have shown a “better efficacy” of the drug “once the artery is opened”, this does not mean that it has to be stopped before thrombectomy, as is currently done: “Only if You have a little drug left after the first administration, save it because it will work very well later, “he advised.
María Barranco is one of the patients who was fortunate to emerge unscathed from the stroke he suffered a year ago: “I was lucky that Dr. Renú’s team took me in right away and now I’ve realized that I was luckier to be in the drug group.”
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