The Hospital Clínic successfully tests a new approach against the sequelae produced by a stroke

Eliminating and minimizing the possible consequences after a stroke is one of the challenges of Medicine.

The

since the times in which the cerebral blood vessels suffer and neuronal areas are damaged are shortened, which has repercussions in the rest of the organism.

A study on ischemic stroke in several Catalan hospitals coordinated by researchers from the Hospital Clínic/Idibaps, Barcelona, ​​and published in the journal

, shows that

just after mechanical thrombectomy, and not just before, as does now, it allows to improve the prognosis of the patients in a significant way.

It is about being able to

, such as streptokinase, urokinase, alteplase and other tissue plasminogen activators,

responsible for the stroke.

This work "

.

Remember that restoring circulation after an ischemic stroke is essential to preserve the function of the affected area of ​​the brain and ensure that patients recover with the least possible sequelae.

Ángel Chamorro, head of the Cerebral Vascular Pathology Unit and of the IDIBAPS Cerebrovascular Diseases research group, has designed and coordinated this study and

.

The first author of the work and coordinator of the essay at the Clinic is Arturo Renú, from the same team.

The study was financed through

the 2016 TV3 Regional Television Marathon, dedicated to stroke and spinal cord and traumatic brain injuries, and

dedicated to stroke care participated: the mentioned Clínic, Germans Trias i Pujol from Badalona, ​​Josep Trueta from Gerona, Bellvitge from L'Hospitalet and Sant Pau, Hospital del Mar and Vall d'Hebron, all three from Barcelona.

Ischemic stroke, which

When the blood does not arrive adequately, the function of the affected part of the brain can be temporarily or permanently altered, reports the Clínic-Idibaps.

During the first hours of the stroke

since, on average, "every minute that passes, two million neurons die. Therefore, treatments that allow blood flow to be restored must be used up to 24 hours after the stroke."

restore circulation

Mechanical thrombectomy, which is performed in these cases, consists of introducing a catheter through the femoral artery through which a stent is advanced to the obstructed artery, with the aim of capturing the thrombus between the meshes of the stent. and extract it after circulation.

It is a

that is only performed in tertiary hospitals with highly qualified professionals.

"In about 80% of cases we get the blood to circulate normally again, but we have observed that after three months the percentage of people who are completely free of sequelae is 27%", explains Chamorro.

"We're much more effective at restoring normal circulation than the clinical efficacy we're seeing," he adds.

This difference in percentages shows that the brain tissue close to the formation of the thrombus is going to die, although the blood circulates with apparent normality again.

What was raised in this study is that, although the main artery is open, there is involvement at the level of the cerebral microcirculation.

"

", says Chamorro.

Treat the unseen

The microcirculation falls below the diagnostic level of cerebral arteriography used to view reperfusion after mechanical thrombectomy.

To restore it, the researchers considered the administration of the fibrinolytic drug, which enhances the dissolution of thrombi and helps restore blood flow, after performing the thrombectomy.

"With this approach,

", says Renú, for his part.

The study published in JAMA involved

treated at tertiary stroke centers in Catalonia.

One group of patients received fibrinolytic therapy (r-tPA) after mechanical thrombectomy and the other group received placebo after performing the same procedure.

The results of the study show that, by administering this treatment,

.

"We are giving a drug that used to be given before carrying out the treatment, to do it later. Thus, first we restore circulation in the main artery and, later, we give the drug, which is effective in dissolving the smallest thrombi," Renú points out. .

"Despite the enormous difficulties caused by the covid-19 pandemic, this clinical trial has obtained

in the treatment of ischemic stroke that will change the clinical guidelines regarding its treatment," says Renú.

Renú points out to this newspaper that until now what has been done is to administer the fibrinolytic to the patient with stroke before catheterization, in a similar way to how it is done in patients with acute myocardial infarction or with pulmonary thrombi (in some cases).

"What we propose is a plus:

".

The

after the first signs in the patient.

Then, to perform the catheterization, there is a limit of 24 hours, counting from the first symptoms.

That term is the same to add, just after the surgical intervention, the new dose of fibrinolytic that is now proposed by the Clínic/Idibaps.

The fibrinolytic used in the study: alteplase

The fibrinolytic used in this study is alteplase (Actylise®), a

, also used in myocardial infarction and pulmonary embolism.

Renú indicates that they do not plan to test another in the same indication because this one "is effective and works in stroke", although it has contraindications.

The Clinic sees about 1,000 cases of stroke a year (about 3 a day) and Renú assures that

in the approach to this disease from the onset of symptoms.

With experience, patients arrive earlier at the reference hospital, which in itself offers them more chances of surviving and avoiding sequelae.

Conforms to The Trust Project criteria

Know more

• Barcelona

• Pharmacology

World Cancer DayCART, the therapies of the future against cancer that erase it in the present

Covid-19Two thirds of adverse reactions to the covid vaccine would be attributed to the placebo effect

Covid-19Vaccination in adolescents prevents serious covid

See links of interest

• Last News

• covid

• Ukraine

• Work calendar 2022

• The reading

• Athletic Club - Valencia CF