Intra-arterial tPA can Reduce Stroke Damage

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

For more than 12 years now, the use of tissue Plasminogen Activator (tPA) has helped to change the course of ischemic stroke. If tPA, or other thrombolytic drugs are delivered intravenously within three hours, the chance of a complete recovery improves by as much as 50 percent. However, when 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 Saint Joseph’s Hospital in Marshfield, have been able to double 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 Vivek Gonugunta, MD, a Marshfield Clinic neuroendovascular surgeon on staff at 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, or on blood thinners or who present after the three hour time window which 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. So educating patients about the symptoms of stroke, and treating a stroke as a true emergency, cannot be emphasized enough, said Gonugunta. He reiterated that time is of the essence. “For every minute after an acute stroke, a couple of million neurons die,” Gonugunta said. “So people who suffer acute stroke should be referred to and taken as soon as possible to a center that can offer specialized endovascular and neurological services.” In addition to acute stroke treatments, endovascular surgeon can also place stents within the narrowed blood vessels within the brain or neck to treat patients suffering from repeated small strokes or TIAs.

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