Clot-retrieval devices failed to improve stroke-related disability
“Future research may show that newer generations of Food and Drug Administration-cleared devices and improved patient care may change the balance of the risk/benefit ratio of intra-arterial treatment for acute stroke. In addition, neuroimaging might be useful in selecting patients who can benefit from intra-arterial therapy,” said Dr. Koroshetz.
Additional information from subset analyses of the IMS III data will be presented at the International Stroke Conference in Honolulu, February 6-8, 2013.
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Stroke and blood clots
Ischemic strokes happen when a blood clot (thrombus) or a fatty deposit blocks an artery supplying blood to the brain. Around 80% of all strokes are ischemic in origin. The remaining 20% of strokes are hemorrhagic, where an artery bursts. These can be caused by an aneurysm, a bulge or weakness in the wall of a blood vessel.
All of us have clotting factors in our blood to ensure we do not bleed to death if we cut ourselves. But conditions like hypertension, atherosclerosis and some other blood problems can lead to the development of blood clots. Thrombosis is the name given to the formation of blood clots. When the clot blocks the blood flow to the heart or the brain, a heart attack or stroke can follow. An embolism occurs when a blood clot travels around the body and lodges in an organ.
Predisposing conditions for thrombosis
Damage to the blood vessels
If the inner walls of a blood vessel (endothelium) are damaged, it makes it easier for blood clots to form. Damage to the endothelium exposes the underlying collagen in the blood vessel and this can promote clot formation.
Atherosclerosis is a common form of endothelial damage that can lead to thrombosis. Other kinds of endothelial damage can arise from physical injury, inflammation, hypertension, infection, radiation and smoking.
Turbulent blood flow causes endothelial injury. Turbulent blood flow occurs when blood vessels are affected by atherosclerosis, abnormal arterial dilations (aneurysms), and heart attack or heart valve damage.
Funding for IMSIII was provided in part through grants from NIH/NINDS (UC U01NS052220, MUSC U01NS054630, and U01NS077304). Other support was provided by Genentech Inc., Boehringer Ingelheim, EKOS Corp., Concentric Medical, Cordis Neurovascular.
References: Broderick, JP et al. “Endovascular Therapy after Intravenous t-PA versus t-PA Alone for Stroke,” New England Journal of Medicine published online February 7, 2013, DOI:10.1056/ NEJMoa1214300.
NINDS is the nation’s leading funder of research on the brain and nervous system. The NINDS mission is to reduce the burden of neurological disease – a burden borne by every age group, by every segment of society, by people all over the world.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.
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IMS-III Investigators
University of Cincinnati Academic Health Center, Ohio: Joseph P. Broderick, M.D.; Judith Spilker, R.N., B.S.N.; Janice Carrozzella, R.N., B.A., R.T.; Pooja Khatri, M.D., M.Sc.; Thomas A. Tomsick, M.D.
Medical University of South Carolina, Charleston: Yuko Y. Palesch, Ph.D.; Sharon Yealts, Ph.D.; Edward C. Jauch, M.D.; Renee L. Martin, Ph,D.; Lydia D. Foster, M.S.
University of Calgary, Alberta, Canada: Andrew M. Demchuk, M.D.; Michael D. Hill, M.D.; Mayank Goyal, M.D.; Karla J. Ryckborst, R.N., B.N.
University of Pittsburgh Medical Center, Stroke Institute, Pittsburgh, Pennsylvania: Tudor G. Jovin, M.D.
Melbourne Brain Centre, The Royal Melbourne Hospital, University of Melbourne, Australia: Bernard Yan, M.D.
University of Toronto, Ontario, Canada: Frank L. Silver, M.D.
University Hospital, Dresden, Germany: Rüdiger von Kummer, M.D.
Hospital Universitari Vall d’Hebron, Barcelona, Spain: Carlos A. Molina, M.D.
Mayo Clinic, Phoenix, Arizona: Bart M. Demaerschalk, M.D.
Riverside Methodist Hospital, Columbus, Ohio: Ronald Budzik, M.D.
Oregon Health and Science University, Portland, Oregon: Wayne M. Clark, M.D.
Medical College of Wisconsin, Milwaukee, Wisconsin: Osama O. Zaidat, M.D.
Alexian Brothers Medical Center, Elk Grove Village, Illinois: Tim W. Malisch, M.D.;
University Medical Centre Utrecht and the Rudolph Magnus Institute of Neurosciences, and the St. Antonius Hospital, Nieuwegein, The Netherlands: Wouter J. Schonewille, M.D.
Bichat University Hospital, Paris, France: Mikael Mazighi, M.D., Ph.D.
Basel University Hospital, Basel, Switzerland: Stefan T. Engelter, M.D.
University of Sydney, Australia: Craig Anderson, M.D.
National Institute of Neurological Disorders and Stroke, Bethesda, Maryland: Scott Janis, Ph.D.
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Kathryn DeMott
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301-496-5751
NIH/National Institute of Neurological Disorders and Stroke