TORONTO – Researchers have shown that a clot retrieval procedure, known as endovascular treatment (ET), can dramatically improve patient outcomes after an acute ischemic stroke by reducing the overall death rate by 50 percent and significantly reducing disability in survivors.
“The results from this trial will change how stroke is treated in Canada and around the world,” says Dr. Rick Swartz (pictured), an investigator on the research team and Medical Director of the Stroke Program at Sunnybrook, one of the study sites. “This is the most significant advance in emergency stroke treatment in the last 20 years, and Canada will be one of the first countries to incorporate this treatment into Stroke Best Practice Guidelines.”
Overall, positive outcomes for patients increased from 30 per cent to 55 percent. In many cases, instead of suffering major neurological disability, patients went home to resume their lives. The overall mortality rate was reduced from two in 10 patients for standard treatment of care to one in 10 patients – a 50 percent reduction with ET.
The clinical trial, known as ESCAPE (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times), shows there is a marked reduction in both disability and death among patients who receive ET for acute ischemic stroke.
Ischemic stroke is caused by a sudden blockage of an artery to the brain that deprives the brain of critical nutrients, such as glucose and oxygen.
Currently, the international standard of care based on Canadian, U.S. and European guidelines is to administer a drug called tPA when appropriate. Known as a ‘clot buster,’ the drug dissolves the blood clot.
In the ESCAPE trial, 316 patients who fit the criteria for ET and arrived for treatment within 12 hours of their stroke were randomized to standard medical care (which included the clot-busting drug tPA where appropriate) or standard medical care plus ET.
ET is performed by inserting a thin tube into the artery in the groin, through the body, and into the brain vessels to the clot. This is done under image-guided care using an X-ray. The clot is then removed by a retrievable stent and pulled out, restoring blood flow to the brain.
“As a stroke clinician, this is an exciting time as this therapy provides us with a new option to stop stroke in its tracks as quickly and effectively as we can when the patient first arrives in the Emergency Room,” adds Swartz. “It further emphasizes how important it is for people to recognize the signs of stroke and call 911 immediately for severe weakness, speech problems or other sudden loss of function. We now have more treatment options, but people must get to the Emergency Room fast.