NEW YORK (Reuters Health) - Mechanical thrombolysis using an endovascular photoacoustic recanalization (EPAR) catheter can quickly restore cerebral blood flow in patients with acute ischemic stroke, physicians report in the May issue of Stroke.
The main goal of mechanical thrombolysis is to quickly restore cerebral blood flow while minimizing the risk of hemorrhage associated with fibrinolytic therapy. It is ideally suited to patients with contraindications to treatment with tissue plasminogen activator, Stephanos Papademetriou told Reuters Health, such as those with a clotting disorder or a history of intracerebral bleeding or who have recently undergone surgery.
Papademetriou is president of Selva Medical (Belmont, California), the company that now holds the patent for the EPAR catheter.
The device delivers laser therapy that is converted to acoustic energy and produces “cavitation bubbles,” which cause the clot to be “sucked” into the catheter tip where it is emulsified.
“To my knowledge, no other method (of mechanical thrombolysis) uses a true emulsification device that gets close to the occlusion and breaks it down to subcapillary-sized particles,” Papademetriou commented.
In the current study, Dr. Ansgar Berlis at the University of Freiburg, Germany, and associates documented outcomes for 34 patients treated with EPAR. “The indication for the treatment of acute ischemic stroke with the EPAR system is a proximal intracranial vessel occlusion with a vessel size of > 2 mm,” Dr. Berlis told Reuters Health.
Recanalization occurred in 11 of 18 patients whose EPAR treatment was completed. Treatment could not be completed in 16 patients because of such factors as vessel anatomy, stenosis or device malfunction. Recanalization was accomplished in three of these patients.
The low rate of recanalization is at least partly due to the 10 patients with internal carotid artery occlusion, which is associated with poor outcome, the authors suggest.
Intraarterial rTPA was administered in 13 patients, primarily “as adjunctive treatment for residual or peripherally located thrombus,” Dr. Berlis explained. One of the two cases of symptomatic intracranial hemorrhage was associated with adjuvant rTPA treatment.
There was one device-related event, which was caused by misuse of the catheter.
Papademetriou expects that results of future clinical trials will be better because the catheter has been redesigned to be operated continuously over a guide wire when the laser is on. And because the catheter is now more flexible and “less kinkable,” it is more easily navigated through tortuous vessels, he added.
Source: Stroke 2004;35:1112-1116. [ Google search on this article ]
MeSH Headings:Drug Therapy: Therapeutics: Thrombolytic Therapy: Analytical, Diagnostic and Therapeutic Techniques and EquipmentCopyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
