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RESEARCH | ESCAPE STROKE TRIAL: NEW THERAPY BENEFITS STROKE PATIENTS

Submitted by aedowd on Tue, 03/01/2016 - 3:23pm

News Release | Media Contact | #ESCAPEstroke 

For Medical Professionals


Canadian researchers have completed an international randomized controlled trial showing that a clot retrieval procedure, known as endovascular treatment (ET), can dramatically improve patient outcomes after an acute ischemic stroke. The study, led by researchers at the University of Calgary’s Hotchkiss Brain Institute (HBI), shows a dramatic improvement in outcomes and a reduction in deaths from stroke. The results of this study were published in the Feb. 11 online edition of the New England Journal of Medicine (NEJM).

Overall, positive outcomes for patients increased from 30 per cent to 55 per cent. 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 per cent 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.

Endovascular treatments were first developed in the 1990s, but ET has only recently been technically possible. The ESCAPE team says the success of the trial can be credited to very fast treatment and the use of brain and blood vessel imaging. In ESCAPE, researchers were on average two hours faster in opening the blocked blood vessels than in previously reported trials.

ESCAPE is the second ET trial that demonstrates the efficacy of the treatment and the first trial to demonstrate reduced mortality. The previous trial, known as MR. CLEAN (Multi center Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands), was published in December 2014.

Brain and Mental Health is one of six strategic research themes guiding the University of Calgary towards its Eyes High goals.

The study was funded by The Heart and Stroke Foundation of Canada, Alberta Innovates-Health Solutions and Medtronic, along with generous donations to the Hotchkiss Brain Institute Stroke Team and the Calgary Stroke Program.


Media Contact

Marta Cyperling
Media Relations Manager, Cumming School of Medicine
403.210.3835
marta.cyperling@ucalgary.ca

Submitted by aedowd on Tue, 03/01/2016 - 11:50am

Warning Signs of Stroke

Think FAST; recognize and react to the warning signs of stroke:

  • F (facial droop)
  • A (arm weakness)
  • S (speech slurred or garbled)
  • T (time to call 9-1-1)

Stroke Facts

  • Stroke is a leading cause of death in Canada
  • Ischemic stroke is caused when blood flow to the brain is blocked
  • In stroke, time equals brain. Each minute the brain is not receiving blood flow, about 1.9 million brain cells die
  • Stroke is the leading cost of serious long-term disability in adults
  • Stroke can happen at any age

ESCAPE Trial Sites

The study included 22 sites worldwide and patients in the U.S., U.K., Ireland and South Korea. Canada had 11 participating hospitals and enrolled two-thirds of the patients.

  • Foothills Medical Centre | Calgary, Alta.
  • Royal University Hospital | Saskatoon, Sask.
  • Colorado Neurological Institute | Denver, Colo.
  • St. Michael's Hospital | Toronto, Ont.
  • UPMC Medical Centre | Pittsburgh, Penn.
  • Queen Elizabeth II HSC | Halifax, N.S.
  • Toronto Western Hospital | Toronto, Ont.
  • University of Alberta Hospital | Edmonton, Alta.
  • Chattanooga Center for Neurologic Research | Chattanooga, Tenn.
  • CHUM-Hospital Notre-Dame | Montreal, Que.
  • MUSC-Medical University of South Carolina | Charleston, S.C.
  • Sunnybrook Health Sciences Centre | Toronto, Ont.
  • Ottawa Hospital | Ottawa, Ont.
  • London Health Sciences Centre | London, Ont.
  • McGill University (MNI) | Montreal, Que.
  • Beaumont Hospital | Dublin, Ireland
  • Abington Memorial Hospital | Abington, Penn.
  • Royal Victoria Hospital | Belfast, N. Ireland
  • Yonsei University (Severance Hospital) | Seoul, South Korea        
  • Samsung Medical Centre | Seoul, South Korea
  • Keimyung University (Dongsan Medical Centre) | Daegu, South Korea
  • Temple University Hospital | Philadelphia, Penn.

ET Brain Scan Images



A good candidate for ET: Multiphase CTA shows occlusion of a large vessel and good collateral circulation (click to enlarge)

Vessel access: CT angiography shows the pathway to get there for ET (click to enlarge)

A tiny tube is inserted through the groin and advanced to the vessels in the neck using X-ray guidance. The area of occlusion is carefully accessed using a tube ~1mm thick and a retrievable stent: The Solitaire stent is deployed and there is instantaneous restoration of blood flow to the brain. The stent is withdrawn; capturing the clot and opening the vessel
(click to enlarge)