Treatment for Acute Stroke: Clot buster or Angioplasty?

There are 2 treatment options for patients suffering from acute stroke. One is a clot buster called t-PA which is given intravenously. The second is a procedure called Angioplasty wherein the blocked artery is opened mechanically by a clot aspirating device or giving the drug directly into the artery with the help of small tubes. In some cases, a stent (spring like device) is placed across the artery.

There has been a long standing debate to know which one is a superior treatment option. Physicians consider the Angioplasty option as superior as the doctor is directly opening the artery by a mechanical device. The drug option is considered inferior as the effect of the drug can be limited in some patients.

So for the first time, both these treatment options were compared directly with each other. They found that the Clot buster was more effective when compared to the angioplasty approach. The study got published in the NEJM, a premier medical journal in the Feb 6, 2013 issue.

362 patients with acute ischemic stroke underwent randomization (181 to endovascular treatment and 181 to drug-tPA). Primary outcome of death and disability was studied at the end of 90 days.

A total of 55 of the 181 patients (30.4%) in the endovascular-treatment group survived without disability as compared with 63 of the 181 patients (34.8%) in the intravenous t-PA, drug group (absolute difference, −4.4 percentage points).

At 90 days, 26 patients in the endovascular-treatment group (14.4%) and 18 in the intravenous t-PA group (9.9%) had died.

This trial failed to show that the Angioplasty approach was superior to the drug option: intravenous t-PA. It also challenged the Physicians common notion that Angioplasty is superior to the drug.

It is a victory of a Drug over a mechanical procedure called Angioplasty. Again, reminding us that with the advent of better drugs, equally good and sometimes more effective treatment can be delivered safely!

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