Surgical Delivery of Clot-Busting Drug Shows Promise

Stroke patients who had surgery to deliver the clot-busting drug tPA directly into the brain experienced better and quicker recovery than those who received standard treatment, according to researchers at the Johns Hopkins School of Medicine.

There are two types of stroke: hemorrhagic and ischemic. Though their symptoms appear similar, they are very different health emergencies that require different treatment.

• Ischemic stroke happens when an artery in the brain is blocked. This causes brain tissue to die in the area served by the blocked vessel. Doctors can unblock the vessel with clot-busting drugs and mechanical devices.
• Hemorrhagic stroke occurs when a weakened blood vessel ruptures and bleeds into the brain. While it is less common than ischemic stroke, it remains a major public health problem.

Doctors haven’t used clot-busting drugs to treat hemorrhagic stroke because they believed it could cause more bleeding. The only options were to monitor the patient or to remove the clot and alleviate intracranial pressure via cranial surgery, which could add risk.

However, Johns Hopkins researchers reported that tPA improved hemorrhagic stroke outcomes in a multicentered study of 96 patients. It appears that tPA not only didn’t cause more bleeding, but also dissolved the clots medically–without surgical removal. The results showed improved early and long-term recovery.

More research is necessary to fully understand the effects of these powerful drugs. But this preliminary work represents real progress in developing safer treatment and management of hemorrhagic stroke patients.

This post was written by David Langer, MD, Director of Cerebrovascular Research
at North Shore University Hospital and Associate Professor of Neurosurgery
at Hofstra North Shore-LIJ School of Medicine.

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