Original title: A Controlled Trial of Revascularization in Acute Stroke. Reference: Martin Roubec et al. Radiology. 2012;Epub ahead of print.
One of the most crucial forecast factors in patients undergoing acute ischemic stroke, stroke caused by a blockage in a brain artery, is the time window to recanalization.
Thrombolytic agents have been proved useful but not always achieve reperfusion and may sometimes be contraindicated. The goal of this study was to analyze the safety and efficacy of brain angioplasty in acute ischemic stroke in patients with failed thrombolysis and those ineligible to receive it.
Within 4.5 hours of onset, from 131 patients (all had a blockage in the middle cerebral artery detected by CT) 75 received thrombolytic agents (IVTs). From these 75, only 26 patients successfully re-opened the blocked artery, the remaining 49 either received brain angioplasty with stenting (n=23) or were assigned to the control group (n=26).
The 56 patients originally ineligible for IVTs were also divided to receive brain angioplasty with stenting (n=31) or to the control group (n=25). Primary end point was favorable outcome defined as a 0 to 2 score in the modified Rankin scale at three months.
Brain angioplasty outcome was superior compared to the control group both for patients with failed thrombolysis (43.5% vs. 15.4% p=0.034 respectively) and patients with contraindication (45.2% vs. 8% p=0.004 respectively).
Symptomatic bleeding rate at 24 hrs and mortality at 7 and 90 days was no different between the groups.
Conclusion
In patients with acute ischemic stroke due to a blockage in the medial brain artery ineligible for IVTs or after failed IVT administration, brain angioplasty with stenting was safe and effective.
Editorial Comment:
In this context, angioplasty seems safe but must be validated by further randomized studies. This trial, as most of trials on stroke, analyzed heterogeneous populations. This is illustrated by the fact that stent selection was left to the operator’s criterion, which resulted in more than 8 different types of stents.
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