Thrombectomy: possible treatment for large ischemic stroke

A new study has obtained positive outcomes for previously untreatable patients who experienced a large ischemic stroke, according to a study published in New England Journal of Medicine. 

The study compared the use of endovascular thrombectomy — a minimally invasive procedure that removes blood clots — to standard medical care for patients who had a stroke caused by a blocked blood vessel in their brain.

The study was carried out across 31 centres in North America, Europe, Australia and New Zealand and was terminated early due to positive results.

Professor Bruce Campbell, joint senior author and director of The Royal Melbourne Hospital (RMH) neurology, said similar results had been discovered during a 2015 study, but that patients with large areas of injury when they arrived in hospital were excluded from that trial and other trials internationally.

This new study has shown that many of those patients still benefit. Since the patients have experienced a severe stroke, many may not be able to return to independence or walking unassisted, but the authors say the reduction in the need for nursing home care and death is substantial.

“This means reduced disability for a substantial number of patients who were previously not considered treatable,” Campbell said.

The results of the study showed that 20% of patients who underwent thrombectomy returned to independent function, compared to only 7% of patients who received medical care alone.

Independent walking occurred in 38% of patients who received a thrombectomy compared to 19% who received the standard medical care.

The trial was terminated early for efficacy after 352 patients had been enrolled in the study.

This study is a significant step forward in the treatment of large ischemic strokes.

“We have seen improved outcomes and functional independence in patients who underwent thrombectomy, which does offer hope to others who may experience a stroke in the future,” Campbell said.

RMH Patient Jack* presented after having a major stroke — the extent of injury on his brain scan would have usually have excluded him from thrombectomy treatment.

He was treated with thrombectomy as part of the trial and had an excellent outcome. Instead of the expected severe weakness, immobility and cognitive effects from such a large stroke, he was able to walk again after only a few days and managed to get back home after just three weeks in rehabilitation.

“I’m so grateful for the care I received, and I feel very lucky to have been part of the trial,” Jack said.

^{*Name changed for privacy}

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