Intra-arterial tPA Stroke Treatment

Vivekananda A. Gonugunta

When a stroke occurs, time is crucial. Every minute that the brain is deprived of oxygen, and treatment to eliminate the blockage in the blood vessel is delayed, more damage is done. 

For more than 12 years, the use of tissue Plasminogen Activator (tPA) has helped change the course of ischemic stroke. If tPA or other thrombolytic drugs are delivered intravenously within three hours, the chance of complete recovery improves by as much as 50 percent.  However, when a patient suffers a major stroke, intravenous tPA alone is often not successful and intra-arterial treatments are beneficial.

Recently, comprehensive stroke centers throughout the country, including Ministry Saint Joseph’s Hospital in Marshfield, have doubled that window of opportunity from three to six hours—by administering thrombolytics intra-arterially.

“The clot-busting drug can be delivered right to the site of the blockage and in many patients, the clot can be retrieved and the blood flow can begin almost immediately,” said Vivekananda Gonugunta, MD, a Marshfield Clinic endovascular neurosurgeon on staff at Ministry Saint Joseph’s Hospital.

The intra-arterial procedure involves inserting a thin, flexible catheter into an artery in the groin and guiding it up to the area of the clot within the brain. A smaller catheter is then inserted through the original catheter to deliver the tPA, and then a special device is deployed to physically pull the clot out of the brain.

The intra-arterial approach is especially beneficial for patients who have recently had surgery, are on blood thinners or who present after the three-hour time window. These patients are often excluded from intravenous drug delivery.

“Treatment of stroke is changing rapidly,” said Gonugunta. “Years ago, our only option was waiting for the stroke to take its course and hope that the damage was minimal, then offer supportive care. Now, that damage can be prevented or dramatically reduced.”

Failure to recognize stroke and get treatment is the primary obstacle to otherwise eligible patients receiving tPA. “For every minute after an acute stroke, a couple of million neurons die,” Gonugunta said.
 

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