Researchers find new therapy benefits stroke patients

Overall mortality rate drops from 2 in 10 deaths to 1 in 10 deaths from stroke

CHARLESTON, SC – Researchers have completed an international randomized controlled trial showing that a specialized 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) and including MUSC researcher Christine Holmstedt, D.O., and other institutions, showed 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) and presented at the recent International Stroke Conference in Nashville, Tennessee.

Overall, positive outcomes for patients increased from 30 percent to 55 percent for those receiving ET along with the standard of care.  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.

“This trial’s results will change our standard of care for stroke patients,” said Holmstedt, MUSC Neurology assistant professor and medical director of Clinical Stroke Services. “With MUSC being part of this pivotal, game-changing trial, we continue to offer the best and most state-of-the –art stroke care in South Carolina.”

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 when provided in a timely manner. 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. ESCAPE is one of three international ET trials presented at the International Stroke Conference this month that demonstrated the efficacy of the treatment, and the first trial to demonstrate reduced mortality.

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, demonstrating the importance of receiving definitive care as quickly as possible.  The findings from these trials will also influence how patients are triaged to stroke hospitals and how hospitals within a region partner for the best care possible.

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

About MUSC
Founded in 1824 in Charleston, The Medical University of South Carolina is the oldest medical school in the South. Today, MUSC continues the tradition of excellence in education, research, and patient care. MUSC educates and trains more than 3,000 students and residents, and has nearly 13,000 employees, including approximately 1,500 faculty members. As the largest non-federal employer in Charleston, the university and its affiliates have collective annual budgets in excess of $1.7 billion. MUSC operates a 750-bed medical center, which includes a nationally recognized Children’s Hospital, the Ashley River Tower (cardiovascular, digestive disease, and surgical oncology), Hollings Cancer Center (one of 66 National Cancer Institute designated centers) Level I Trauma Center and Institute of Psychiatry. For more information on academic information or clinical services, visit www.musc.edu. For more information on hospital patient services, visit www.muschealth.org.