For patients suffering an ischemic stroke, stenting or clot-busting drugs may offer the best chances for successful intervention. What’s more, local anesthesia rather than general anesthesia may increase survival rates.

 

Those findings were presented in February at the International Stroke Conference in San Antonio by Vanderbilt University researcher Rishi Gupta, MD. Gupta is an assistant professor of neurology, neurological surgery and radiology.

 

“We collaborated with 13 academic centers in the country, and we were looking at patients who had acute stroke therapy with interventional techniques,” Gupta explained. Vanderbilt and the other participants didn’t receive any outside funding for the study. “We were just operators getting together as a scientific group,” he said.

 

The first study concerned the choice of anesthetic and involved 1,122 patients; roughly half the patients received general anesthesia and the other half local sedation. “The patients who underwent the therapies with general anesthesia had a substantially higher death rate and worse clinical outcomes,” Gupta said, “and there were no differences in safety.”

 

The astounding results have prompted the National Institutes of Health to consider reassessing the protocols of some trials to determine if anesthesia requirements need to be altered, Gupta added. He surmised that there are two reasons why general anesthesia might be a problem. “When you put somebody under general anesthesia, you drop their blood pressure significantly. When you drop the blood pressure, the blood flow to the brain tissue is reduced, and I think the stroke expands,” he said. “Also, there are time delays with general anesthesia, which involves an anesthesia team, so you lose a lot of time and every minute counts.”

 

The second study examined the interventional preferences of physicians working to restore blood flow without hemorrhage within eight hours after an ischemic stroke. Studying 1,056 severe stroke patients, the researchers looked at several techniques: intra-arterial tPA, the clot-busting drug; intravenous delivery of tPA via the arm; intracranial stenting; the Merci Retriever, a corkscrew-like device threaded into the blocked vessel to pull out the clot; the Prenumbra aspiration catheter, which uses suction to remove the clot; angioplasty without stenting; and the use of glycoprotein llb/llla antagonists, which act as anticoagulants.

 

“What we found is that the use of stents gives the highest chance of opening the artery when compared with the Merci device, the Prenumbra device or angioplasty,” Gupta said. Blood flow was restored in 76 percent of stented patients and 72 percent of those receiving tPA directly to the brain, while overall blood flow was restored in only 69 percent of patients treated with other drug techniques or interventions. Thus, the stenting and tPA findings were the most statistically significant.

 

Three months of follow-up is now under way.