A treatment against brain attacks

A treatment against brain attacks

In combination of two techniques, interventional neurology is very effective against stroke (stroke). .

A new emergency procedure for the management of stroke has just been developed at Bichat Hospital. Conducted in coordination with the Samu, firefighters and neurovascular reception centers (there are eight in Paris intramural), it is decisive to unblock and recanalise the clogged cerebral artery or cerebral arteries and improves considerable survival rate. For now, this is only a clinical research experiment conducted only in this establishment, and a few dozen patients. The Recanalise study led by Prof. Pierre Amarenco at the center for the treatment and treatment of stroke in this hospital has just been published by The Lancet Neurology.

Of the 150 000 strokes that occur each year in France, 30 000 affect subjects under 50 years. Sudden motor weakness or paralysis of a hemi-body, a sudden speech disorder, dizziness, a visual disturbance, a numbness of a body part must immediately, it is an absolute urgency to consult. For fifteen years, the reference treatment recognized by the French Agency for Health Safety of Health Products (Afssaps), for patients with stroke by occlusion of a cerebral artery, is an intravenous treatment based on an enzymatic drug. tissue plasminogen activator (RTPA) which dissolves the clot.

This treatment cures the patient in 40% of cases but only if the injection is made less than three hours after the first symptoms. And the RTPA does not open the blocked artery of the brain in 25 to 60% of cases (and 30% of patients relapse secondarily their artery).

Another approach is to deliver the drug directly to the clot: the end of a microcatheter is mounted by the femoral artery, the iliac artery, the aorta, and the carotid artery. RTPA is injected in contact with the clot (kissing the clot). Performed within six hours, this technique can lead the artery in 60 to 70% of cases.

Injected in contact with the clot

Finally, doctors imagined (and use experimentally) microscopic lassos, baskets or corkscrews embedded at the end of catheters to mechanically remove the clot.

The Recanalise study combines the two treatments: as soon as the diagnosis of stroke is made by imaging at the hospital, the RTPA is injected into a vein. Without wasting time, the patient is taken to the catheterization room. A probe is mounted in its artery and the same drug is injected in contact with the clot.

Initially, the Bichat team treated by intravenous treatment only 107 of the 173 consecutive strokes between February 2002 and April 2007. Result: 52% of arteries were "recanalized" (uncorked). Then between May 2007 and October 2008, the intra-arterial technique was added for 53 of the 122 patients included in this group: and recanalization was effective in 87% of cases. The impact on the number of immediate cures was significant: 60% of patients treated with the new method had their symptoms improve or disappear, compared to 39% of patients treated with conventional intravenous.

The faster the artery is cleared, the better the result: if the procedure is less than 3 hours 30 minutes after the onset of stroke symptoms, 93% of the patients are cured immediately and remain so after three months of follow-up.

Only problem, this race against the clock will be expensive in human resources and operation of neurovascular emergencies, mobilized in parallel with the specialists of neuroradiology.

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