Dramatic results from a new clinical trial are set to change the way many strokes are treated in Canada and around the world.
From left, Dr. Andrew Demchuk, Dr. Mayank Goyal and Dr. Michael Hill.
A new treatment was shown to cut in half the death rate from major ischemic strokes in the ESCAPE trial, which was co-funded by the Heart and Stroke Foundation.
Results of the trial, published in the New England Journal of Medicine, also showed reductions in stroke-related disability.
“This is the most significant and fundamental change in acute ischemic stroke treatment in the last 20 years,” says Dr. Michael Hill, senior author of the study and a professor at the University of Calgary’s Cumming School of Medicine. “These results will impact stroke care around the world.”
An estimated 62,000 strokes occur each year in Canada. That’s one every 9 minutes.
The researchers studied 316 people who were diagnosed with a major ischemic stroke, which occurs when a larger artery to the brain becomes blocked by a blood clot.
In the test group, high-tech equipment and imaging was used to remove the clot through the patient’s blood vessels, restoring blood flow to the brain.
Using a procedure called endovascular thrombectomy (ET), doctors insert a thin tube through an artery in the patient’s groin, guiding it with X-ray imaging through blood vessels to the brain. There a retrievable stent or “stentriever” is used to remove the clot.
Death rate cut in half
The researchers found a 50 per cent reduction in the overall death rate among the patients who were treated with ET. The study also showed an increase in positive outcomes for patients to 55 per cent from 30 per cent.
Many people who might have suffered a major neurological disability instead went home to resume their lives.
Stroke is a leading cause of death and disability. Until now the standard treatment has been the drug tPA, when appropriate, to dissolve the clot. About 80 per cent of strokes are ischemic.
While ET is not a new procedure, the ESCAPE trial tested its effectiveness in a new model of care that relies on:
- Imaging for diagnosis: Innovative imaging was used to quickly identify which patients could receive ET.
- Speed: Coordinated hospital workflow and teamwork was essential to getting them treated fast.
- Novel technology: The stentriever was used with X-ray imaging to guide it to the blockage.
“Research is at the core of our race to save lives and create more survivors,” says David Sculthorpe, CEO of the Heart and Stroke Foundation. “A breakthrough like this will have an immediate impact, and it reminds us why the Foundation is so committed to funding Canada’s best researchers – thanks to the generosity of our donors.”
Sculthorpe said the findings underline the need to act fast when someone has a stroke. He urged Canadians to learn FAST – an easy way to remember the major signs of stroke. FAST stands for:
Face – is it drooping? Arms – can you raise both? Speech - is it slurred or jumbled? And Time – to call 9-1-1 or your local emergency number right away.
Results to change best practices
The Heart and Stroke Foundation will move these findings into practice by incorporating this advance into the Canadian Stroke Best Practice Guidelines – making Canada one of the first countries in the world to incorporate this treatment into the healthcare system.
The ESCAPE trial (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times) was conducted in 22 sites in Canada, the United States, Ireland and South Korea.
The team was led by Dr. Hill, a stroke neurologist, and two co-principal investigators – neuroradiologist Dr. Mayank Goyal and stroke neurologist Dr. Andrew Demchuk – all of the University of Calgary. "The ESCAPE trial is very much a collaboration between Stroke Neurology and Neuro-intervention," says Dr. Hill. "It has been a huge team effort."
The Heart and Stroke Foundation provided funding through Dr. Hill’s Heart and Stroke Foundation/Hotchkiss Brain Institute Professorship in Stroke Research and Dr. Demchuk’s Heart and Stroke Foundation Chair in Stroke Research. Other funders were Alberta Innovates-Health Solutions and Medtronic, along with donors to the Hotchkiss Brain Institute Stroke Team and the Calgary Stroke Program.