Thrombectomy

In a 2017 follow-up to the REVASCAT trial, which found reductions in stroke-related disability three months after undergoing thrombectomy, the effects of thrombectomy on stroke-related disability after twelve months were investigated. It was found that thrombectomy still reduces stroke-related disability twelve months after the procedure.

 

Clinical trials have shown thrombectomy – the surgical removal of blood clots – alone or in concert with blood thinners to be effective for the treatment of ischemic (blockage-caused) stroke, reducing both symptoms and disability 3 months after the procedure. Whether the benefits of thrombectomy remain long-term, however, is unknown.

In a 2017 follow-up study published in Lancet Neurology, researchers investigated the effect of thrombectomy on stroke-related disability and quality of life 12 months after the procedure. Participants of the 2015 Spanish REVASCAT trial, in which acute stroke patients were treated with a thrombectomy device and the standard blood thinner alteplase (the thrombectomy group) or alteplase alone (the control group), were reassessed up to 1 year after their entry into the REVASCAT trial. At 3 and 12 months, modified Rankin Scale (mRS) scores were used to assess degree of disability from 0 to 6, with 0 representing no disability and 6 representing death. Further analysis was performed, grouping mRS scores from 0-2, representing high functional independence, and 5-6, representing severe disability and death. Quality of life was assessed at 3, 6, and 12 months after thrombectomy based on the EQ-5D questionnaire, scoring health from -0.33 to 1, with higher scores representing greater quality of life.

At 12 months, the odds of an improved mRS score was 1.80 for thrombectomy patients compared to controls. The proportion of patients who were functionally independent was 44% in the thrombectomy group and 30% in the control group. Improvements in functional independence gained between 0 and 3 months were found to be sustained at 12 months for both groups. Average EQ-5D scores were 0.08 points higher at 3 months, 0.10 points higher at 6 months, and 0.12 points higher at 12 months in the thrombectomy group than in the control group. Overall, mortality rates at 12 months were not significantly different between the two groups.

Overall, the study findings suggest that thrombectomy still reduces stroke-related disability twelve months after application. Moreover, functional independence was found to be higher among thrombectomy patients than control patients – essentially, 1 case of death or severe disability was prevented per 7 thrombectomy patients. As the benefits of device-assisted thrombectomy for acute stroke victims observed at 3 months are sustained 12 months after the initial procedure, the technique may therefore provide a cost-effective addition to traditional therapy. Further, results seen at 3 months may serve as indicators of long-term functionality and quality of life.

 

Written By: Raishard Haynes, MBS


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