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http://www.imt.ie/clinical/2015/03/results-international-study-may-transform-stroke-treatment.html
Results of international study may transform stroke treatment
Prof David Williams, Associate Professor in Geriatric and Stroke Medicine, RCSI and Consultant Stroke Physician at Beaumont Hospital; and Dr John Thornton, Consultant Neuroradiologist, at Beaumont Hospital.
Researchers from the RCSI and Beaumont Hospital have taken part in a major international study that is set to revolutionise the treatment of stroke.
The research — published in the online edition of the New England Journal of Medicine— has shown that a clot retrieval procedure, known as endovascular treatment (ET), results in a dramatic improvement in patient outcomes and a reduction in disability and deaths from stroke.
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.
The international randomised controlled trial led by researchers at the University of Calgary’s Hotchkiss Brain Institute (HBI) was carried out at 22 sites worldwide, and included patients referred to Beaumont Hospital from 10 centres across Ireland, and from hospitals in Canada, the US, the UK and South Korea.
The study involved patients who had suffered an acute ischaemic stroke.
Overall, positive outcomes for patients receiving the new ‘clot removal’ treatment 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 by 50 per cent, from two-in-10 patients for standard treatment of care, to one-in-10 patients out of those who received the new treatment. Up to now, the current standard treatment involved administering medication to dissolve the clot.
Prof David Williams, Associate Professor in Geriatric and Stroke Medicine, RCSI and Consultant Stroke Physician at Beaumont Hospital, andDr John Thornton, Consultant Neuroradiologist at Beaumont Hospital, were the co-leads in Ireland for the study.
“The results of this study represent the most significant development in stroke treatment in the past 20 years and will impact stroke care in Ireland and around the world. More than 10,000 people in Ireland are admitted to hospital with stroke annually and many of those who survive are left with significant disabilities. This treatment has the potential to improve survival rates and quality of life of more than 15 million people worldwide who suffer a stroke each year,” Prof Williams said.
The clinical trial, known as ESCAPE (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalisation times), shows there is a marked reduction in both disability and death among patients who receive ET for acute ischaemic stroke.
In ESCAPE, 316 patients who fit the criteria for ET and arrived for treatment within 12 hours of their stroke were randomised to standard medical care (which included the clot-busting drug tPA where appropriate) or standard medical care plus ET. The primary outcome favoured the intervention (common odds ratio, 2.6), and the intervention was associated with reduced mortality (10.4%, vs. 19.0% in the control group).
Beaumont was the largest patient recruiting site for the study outside Canada, with 34 patients taking part in the randomised trial over six months. “There was impressive collaboration between stroke centres; doctors and nurses; and transport services as well as the radiology team in Beaumont where all the procedures were performed,” commented Dr John Thornton.
NEJM, DOI: 10.1056/NEJMoa1414905.