Delivery of drug tPA directly into brain helps stroke patients

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In an update to previous research, Johns Hopkins neurologists say minimally invasive delivery of the drug tPA directly into potentially lethal blood clots in the brain helped more patients function independently a year after suffering an intracerebral hemorrhage (ICH), a deadly and debilitating form of stroke.

Rates of functional recovery with the active tPA treatment far surpassed those achieved with standard “supportive” therapy that essentially gives clots a chance to shrink on their own.

ICH is marked by bleeding from a blood vessel in the brain that causes a clot to form and is often caused by uncontrolled blood pressure.

In the current Johns Hopkins-led study, ICH patients who randomly received the minimally invasive surgery to deliver a drug designed to dissolve their golf ball-sized clots went home from the hospital an average of 38 days sooner than those receiving supportive therapy.

ICH has long been considered surgically untreatable under most circumstances; roughly 50 percent of people who have such a stroke die from it.

“This is the most promising treatment that has come along in the last 30 or 40 years for people who have suffered hemorrhagic stroke,” says study leader Daniel F. Hanley, M.D., a professor of neurology at the Johns Hopkins University School of Medicine.

Participants in the Minimally Invasive Surgery plus tPA for Intracerebral Hemorrhage Evacuation (MISTIE) trial were treated at the 25 sites in the United States, Canada and Europe.

Surgeons at each site performed the procedure by drilling a dime-sized hole in each patient’s skull close to the clot location. Using a CT scan that Hanley likens to “GPS for the brain,” they guided the catheter through the hole and directly into the clot. The catheter was then used to drip small doses of tPA into the clot for several days, shrinking the clots roughly 20 percent per day. Those patients who underwent supportive therapy saw their clots shrink by about 5 percent per day.

Hanley says the treatment got rid of much of the clot safely, without cutting through easily damaged brain tissue or removing large pieces of the skull.

Source: Johns Hopkins Medicine, USA

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