New stroke treatment no more effective than the current one
Three long-awaited studies have shown that mechanically removing a blood clot from a stroke patient's brain is no more useful than the older treatment of giving an IV dose of a clot-dissolving drug to the whole body.
The results of the clinical trials, presented this week at a meeting in Hawaii, shocked and surprised stroke physicians. Many had already adopted the more aggressive strategy over the last decade.
“For the stroke field this is a really big deal,” Walter Koroshetz, deputy director of the National Institute of Neurological Disorders and Stroke, said of the findings, which were presented over three days at the International Stroke Conference in Honolulu.
The institute paid for two of the trials, one of which cost $27 million. One study took eight years to complete because it was so difficult to enroll patients willing to take the chance they'd be randomly assigned to get the older treatment.
Practitioners hoped that “endovascular treatment,” in which a catheter is threaded into a blocked artery and the clot pulled out, would do for stroke patients what it has done for heart attack patients. In them, going after clots with angioplasty balloons and stents is clearly more effective than giving clot-dissolving drugs through a vein in the arm.
“We did this study with the strong expectation that we would find a positive benefit. We were surprised,” said Joseph P. Broderick of the University of Cincinnati Neuroscience Institute, who headed one of the studies.
His view was echoed by Alfonso Ciccone, a neurologist from Milan who led a clinical trial in Italy: “We were surprised. We wanted the superiority of endovascular treatment.”
Insurance companies and Medicare, the health insurer for the elderly, already cover the endovascular procedure. It costs about $23,000 compared to $11,000 for acute stroke treatment using intravenous clot-dissolving (“thrombolytic”) drugs.
Further, many practitioners believe that newer clot-retrieving devices work better than the ones used in the three trials. Because endovascular procedures were shown to be no more dangerous than IV thrombolytics, physicians may continue to perform it and assume the outcomes can only get better.
“Will it change practice? That's a good question,” said Koroshetz. “The payers may look at this and wonder if they should continue paying for these procedures. If it gets to that point, then clearly things will change.”
Stroke is the fourth-leading cause of death.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Naked man still locked up
- Feds put brakes on green energy edict of renewable fuel standard
- Test vaccine to fight Ebola promising
- Fewer adults smoking, U.S. survey finds
- Supreme Court will hear challenge to EPA’s power-plant rules
- National Guard reinforcements contain damage in Ferguson
- Supreme Court Justice Ginsburg has surgery for coronary blockage
- 2 FBI agents shot, wounded in St. Louis area
- Is Obama order on firm legal ground? Probably
- Convenience stores, movie theaters, amusement parks to fall under new FDA nutrition labeling rule
- Brown family blasts prosecutor; Wilson speaks