Removing clots 'offers better stroke treatment than drugs'

Removing a clot from a blocked artery is likely to be a more effective treatment for stroke than medication, according to new research.

In a study known as MR CLEAN, researchers examined 500 patients in the Netherlands and found 33 per cent achieved functional independence after surgical intervention, compared with 19.1 per cent who received only the usual care with clot-dissolving drugs.

Acute Stroke Intervention director at Massachusetts General Hospital Dr Albert Yoo said "We're talking about the sickest stroke patients, the ones with blockages of their main arteries leading to the brain, and these patients account for the majority of disability and death related to stroke."

The reason behind the success is thought to be the invention of a new method to remove the clots - a stent on the end of a catheter that is inserted in the groin and passed through an artery to the brain.

When the stent reaches the clot, it is opened and pushed into it. This catches the clot and enables its extraction along with the catheter.

All the patients involved in the study received treatment with the devices directly within six hours of the onset of symptoms.

Ninety per cent were given tPA, a clot-dissolving drug. Half were randomly assigned to get a second treatment as well, with the majority being treated with the new stent.

Previous attempts to remove clots directly have run into difficulties, the New York Times reports. Some could cause bleeding in the brain, while dislodged parts of a clot could result in further blockages. The treatment was also more expensive than using drugs.

The new stent, however, appears to offer a safer method of treatment, while new technology has enabled doctors to quickly determine the location and size of clots.

"This is a game changer," said Dr Ralph Sacco, chairman of neurology at the University of Miami’s Miller School of Medicine. Dr Joseph Broderick, director of the neuroscience institute at the University of Cincinnati, described it as a "sea change".

The study is available online in the New England Journal of Medicine.

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