Endovascular therapy trumps tPA for distal stroke clot treatment

When it comes to hard-to-reach blood clots, endovascular therapy is an effective—and superior—method to medical management, according to a recent study by the University of Texas Health Science Center.

Strokes caused by blood clots that form in large vessels such as the internal carotid artery are proven to be less responsive to the tissue plasminogen activator, the FDA approved treatment that works to dissolve clots and improve blood flow to the brain.

While endovascular therapy is effective for removing blockages in the first segment of the internal carotid artery, it had not yet been determined whether the method was safe and effective for blockages in a more distant segment of the artery, known as M2. Amrou Sarraj, MD, an assistant professor of neurology at McGovern Medical School at UTHealth, was part of a team to determine if this minimally-invasive procedure would be successful.

The study examined 522 patients with large vessel occlusion in the M2 segment. From that group, 288 received endovascular treatment while 234 were medically managed. The endovascular group saw 63 percent of patients receive “good outcomes,” while only 36 percent of the medically managed group received similar results.

The results were published in JAMA Neurology.

“This is a group of stroke patients that has been underrepresented in trials testing endovascular treatment for strokes. Further research in the form of a randomized clinical trial needs to be done to confirm our findings,” Sarraj said in a statement. “We hope that in the meantime, the results of this study support that patients with M2 occlusions who have disabling neurological deficits should be heavily considered and probably treated with endovascular therapy to give them the best chance of a better outcome.”