Researchers at the University of Calgary’s Hotchkiss Brain Institute are making international headlines once again but this time with a new therapy that promises to improve outcomes and reduce death in stroke patients.
Scientists conducted an international randomized controlled trial that uses endovascular treatment or ET to retrieve clots that occur in patients who suffer an ischemic stroke.
"This breakthrough has the potential to improve the lives of the 15 million people who suffer strokes worldwide each year," said Ed McCauley, PhD, vice-president (research), University of Calgary.
"This remarkable achievement by the HBI Stroke Team is a shining example of brain research at its very best," said Samuel Weiss, PhD, HBI Director and leader of the University of Calgary's Brain and Mental Health strategy.
Ischemic strokes are caused by a sudden blockage of an artery to the brain resulting in the deprivation of critical nutrients like glucose and oxygen.
The current international standard for treatment is to administer a drug called tPA to dissolve the blood clot.
The new therapy is called ESCAPE, Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times.
ESCAPE combines the use of tPA with ET and involves the insertion of a thin tube into the artery through the groin which is then weaved through the body to the brain. Doctors are then able to remove the clot with a retrievable stent and pull it out, restoring blood flow to the brain.
316 patients were part of the trial and arrived for treatment within 12 hours of their stroke. Some received standard medical care, which included tPA, and some were given standard medical care plus ET.
Researchers say positive outcomes for patients increased from 30 to 55 percent with the new therapy and the overall mortality rate was reduced by 50 percent.
"This is the most significant and fundamental change in acute ischemic stroke treatment in the last 20 years. These results will impact stroke care around the world," said Dr. Michael Hill, senior author of the study and professor in the Cumming School of Medicine's departments of clinical neurosciences.
“This is a pretty substantial move forward for the treatment of these patients with acute ischemic stroke and many more patients were able to go back to their families and lead productive lives and be independent,” said Dr. Mayank Goyal, Professor of Radiology U of C.
ET treatments were first developed in the 1990s but have only recently become technically possible.
The U of C team says the trial’s success can be attributed to very fast treatment and the use of brain and blood vessel imaging and say researchers were able to open the blocked blood vessels about two hours faster than in previously reported trials.
"Key reasons for the success of the trial were, firstly, selecting appropriate patients using novel imaging technology; secondly, better organization and workflow to expedite treatment; and thirdly, use of modern technology to open the blood vessels," said Dr. Mayank Goyal, professor of radiology and clinical neurosciences at the Cumming School of Medicine. “We believe that with the combined results from this trial and other trials, this will become the standard of care."
The procedure is being done at the Foothills Medical Centre and is the first trial of its kind to demonstrate reduced mortality.
Basma Kholrussi had a stroke last year and had the procedure done at the end of August.
“It’s amazing. It’s a miracle. This kind of thing saved my life,” said Kholrussi. “No pain, no side effects, it’s like new. I’m new like before.”
22 sites worldwide were included in the study and involved patients from Canada, U.S., U.K., Ireland and South Korea.
The results of the trial were published in the Feb. 11 online edition of the New England Journal of Medicine and will also be available in the March 19 print edition of NEJM.
For more information on ESCAPE, click HERE.