A new study suggests that certain stroke patients could benefit from angioplasty and the placement of brain stents to open the arteries.The finding of this most recent study has a focus on ischemic strokes, which are attacks that occur when the blood flow to the brain is blocked, usually by a fatty deposit, leading to blood flow stopping in that area. In brain angioplasty, a balloon-tipped catheter is guided to the area of the blockage and then the balloon is inflated to re-open the blocked vessel. A stent, a mesh tube, is then inserted so that the vessel remains open and the balloon is deflated. In the study, 131 ischemic stroke patients in the Czech Republic were analysed, with an average age of 66. 75 percent of the patients were given a clot-busting drug whereas the rest were not eligible and were given nothing. Because of these limitations, many ischemic stroke patients had no treatments at all.
However, of the patients who received the clot-busting drug, 35 percent of them had a positive outcome within three months after their stroke. Among those patients in which the drug failed to re-open the artery, less than half underwent the brain angioplasty and stent replacement. The rest had no treatment at all. Among the patients who didn’t receive the drug, 31 went on to have an angioplasty and stenting, and 25 had no further treatment. There were favourable outcomes in 45 percent of those who had the stenting and angioplasty.
For patients with this type of blockage, who can’t receive the drug that could benefit them, re-opening the vessel with stents is considered far more beneficial than having no further therapy, according to researchers. Two experts in the US say that the usefuleness of this approach is still being debated, but it offers hope for those undergoing these problems. DR Keith Siller is the medical director for the Comprehensive Stroke Care Centre in NYU Langone Medical Centre, in New York City. He has claimed that although the Czech study clearly found a real benefit to patients who had an ischemic stroke, another trial which is referred to by the acronym SAMMPRIS concluded that patients with a recent stroke from long-standing blockages in the brain arteries had a worse outcome from angioplasty and stenting than those using normal medications, such as aspirin and statin when combined with aggressive risk-factor modification, such as diet and exercise.
However, Siller stated that the Czech trial used similar stents but focused on a different and less easily managed subset of patients, who were already kown to have the worst outcomes if their arteries remained blocked. He believes that these patients the angioplasty and stenting led to a far better clinical outcome and less hemorrhagic complications with results that were far superior to the patients in SAMMPRIS. Siller claims that the benefits for angioplasty and stenting could play an important role for worst-case patients, but there is still little proof in less urgent cases where the goal is simply to limit it happening again. Based on this study, the stenting process in the acute stroke setting could well be an option for patients who have contraindications for clot-busting drugs, according to DR Rafael Ortiz who is the director for the Centre fro Stroke and Neuro-Endovascular Surgery and Lenox Hill Hospital in New York City. Further studies and more in-depth information needs to take place in order to make final recommendations about the safety of the therapy in other patients.