Ask Dr. H: Drugs, not stents, to treat a stroke

Question: If a stroke is like a heart attack in the sense that a blocked artery causes the damage, why can't doctors use stents to open up blood vessels in the brain to get blood flowing again, as they do for the heart?

Answer: For the types of strokes caused by an acute blockage of a critical blood vessel amenable to a stent procedure, it would seem like using a stent to get the vessel open as soon as possible to restore blood flow would make sense. It turns out that stents are not a good idea when it comes to the brain. Use of a clot-busting drug given within a few hours of the onset of a stroke, plus aspirin and drugs such as Plavix afterward, seems to work much better than trying to get a blocked brain artery open with a stent.

The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study of 451 stroke patients, published in the New England Journal of Medicine, found that within a month after treatment, folks who had received stents died more often or had more strokes (14.7 percent) than those treated with medical therapy alone (5.8 percent). Over less than a year of follow-up, 20.5 percent of the stented patients died or had another stroke, compared with 11.5 percent of those who received medical treatment alone. Medical therapy is still the best option here.

A complex reaction causes rigor mortis

A: The mystery of death and what lies beyond has long fascinated man. From a biological view, death is a much simpler concept. It's not an event, but a process. This is because the various tissues and organs in the living body die at different rates.