Major international study finds thrombectomy highly effective treatment for large strokes (“Huge improvement”)

Medical Xpress / University Hospitals Cleveland Medical Center / New England Journal of Medicine ^ | Feb. 10, 2023 | Amrou Sarraj et al

[ConservativeMind]

A large international clinical study finds that patients with large strokes had a dramatically better recovery after endovascular thrombectomy plus medical management than patients receiving only standard medical management.

Endovascular thrombectomy is mechanical recovery of a clot blocking blood flow in an artery.

The SELECT2 study was stopped early because of the successful results seen in patients who received thrombectomy versus medication only.

Amrou Sarraj, MD, said, "We went on to challenge the current practice where patients with large strokes would be precluded from thrombectomy."

While thrombectomy has proven effective in smaller strokes, patients with large strokes were considered too high risk for the procedure. Size of a stroke is determined by range of damaged brain tissue seen through CT or MRI scans.

"These patients are left to receive medical management only, and a significant number of them end up with very poor outcomes; being wheelchair bound, bed ridden, or dead," said Dr. Sarraj.

"This is a huge opportunity for improvement at a very large level, especially since these patients account for 20 to 25 percent of all large vessel occlusions."

The patients were randomly assigned to one of two groups: 178 received thrombectomy and 174 received medical management. Patients who were seen prior to 4.5 hours from onset of stroke received clot-buster drugs TPA or TNKase if eligible.

"We found that almost 20 percent of the patients who received a thrombectomy ended up with functional independence, going back to their family, to the society as almost normal or not needing support, compared to 7 percent for medical treatment only. We also found that almost 40 percent of the patients end up ambulating independently," said Dr. Sarraj,

"This is a huge improvement in these patients with large strokes who are not being offered the treatment at this point."

[ConservativeMind]

You definitely want the thrombectomy.

[ConservativeMind]

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[Red Badger]

Makes sense to me, and I have had a large blood clot in my left leg in 2020...................

[DannyTN]

Sounds like it, but we are talking brain surgery here right. “Mechanical recovery of the clot”

Uncle Fester: [Speaking to Wednesday] It’s where I got my first lobotomy. But you know lobotomies, they’re like tattoos: You can’t get just one.

[catnipman]

“Sounds like it, but we are talking brain surgery here right.”

nope ... it’s a catheterization procedure ... no cutting ... just an artery is punctured (usually the Femoral) to provide entry for the intra-arterial catheter ...