Dissolving blood clots in the brain

A new international treatment, which will help treat stroke patients by combining minimally invasive surgery, an imaging technique and the clot-busting drug t-PA, has been proven safe and effective.

The novel treatment was developed for patients with intracerebral haemorrhage (ICH), which is a bleed in the brain that causes a clot to form within brain tissue.

The clot builds up pressure and leaches inflammatory chemicals that could cause irreversible brain damage, often leading to death or extreme disability.

The usual treatments for ICH are either general supportive care such as blood pressure control and ventilation, or invasive surgeries that involve removing portions of the skull to remove the clot. Both treatments have similar mortality rates, ranging from 30% to 80% depending on the size of the clot.

Seeking to improve these mortality rates and ICH patients’ quality of life, Professor Daniel Hanley at the Johns Hopkins University School of Medicine in Baltimore, developed and tested the new treatment on 60 patients at 12 hospitals in America, Canada, the United Kingdom and Germany.

The results focused on 11 patients who received only the supportive care treatment.

After neurologists diagnosed patients in the supportive care treatment group with ICH, surgeons drilled small holes close to the clot in the patients’ skulls.

Using high-tech neuro-navigational software that provides detailed brain images, the physicians threaded catheters through the holes and directly into the clots.

They used these catheters to drip t-PA into the clot for up to three days every eight hours using either 0.3 mg or 1mg of the clot-busting drug.

The researchers found the clot size in patients treated with either dose shrunk by more than half, compared to only 1% in patients who received only supportive care.

A comparison of daily CT scans showed patients whose catheters were most accurately placed through the longest part of the clot had the most effective clot size reduction.

Those in the supportive care group had about a 10% mortality rate at 30 days after treatment, lower than the typically high mortality rates expected for this condition.

Tracking the patients’ progress months after the procedure revealed the patients scored significantly higher on a test that measured the ability to function in daily life compared to those who only received supportive care.

The researchers said the new treatment appeared to be a viable and promising alternative to the current standard treatments of supportive care or invasive surgery.

“We’re confirming that patients do recover better if we remove as much of the clot as we can, but gentle removal appears to be the key,” researchers said.

“Reducing the clot’s size with a minimally invasive method seems to be pivotal for optimising patient recovery.”