Seek another route for TPA administration
Intra-arterial delivery has its ups and downs
Recombinant tissue-type plasminogen activator (TPA) was approved by the Food and Drug Administration nine months ago for intravenous administration for acute ischemic stroke. Researchers are now looking for faster, more effective ways to administer the drug.
One technique may involve delivering the drug directly into the brain artery that houses the clot. Such intra-arterial delivery would require a smaller dose and potentially reduce the risk of bleeding complications. In addition, the procedure would allow physicians to physically disrupt the clot with a catheter if it didn’t dissolve.
Clinical trials don’t exist supporting the efficacy of direct intra-arterial administration of TPA, but even if they did, the procedure carries a major limitation: A specialized medical team experienced in neurointerventional techniques would be required, and assembling such a team and workplace takes critical time. And clearly, access by the general public would be limited estimated at 36% by a presenter at the American Heart Association’s 22nd International Joint Conference on Stroke and Cerebral Circulation last month in Anaheim, CA.
In addition to possible alternate routes, research is being conducted on the possible administration of TPA further out than three hours. If new time parameters can be developed, patients who otherwise meet criteria but who present later than three hours after onset can be randomized to a study.
New neuroprotective agents are in the pipeline as well, but unless the area that has been occluded can be opened, neuroprotectives are ineffective. Two agents lubelozole and citicoline had positive studies in the United States and have been submitted to the FDA, but remain unapproved.
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