Endovascular Therapy Improves Outcomes In Acute Ischemic Stroke

Michael D Hill, MD MSc FRCPC Calgary Stroke Program Professor, Dept Clinical Neurosciences Hotchkiss Brain Institute University of Calgary, Cumming School of Medicine Calgary, CanadaMedicalResearch.com Interview with:
Michael D Hill, MD MSc FRCPC
Calgary Stroke Program
Professor, Dept Clinical Neurosciences
Hotchkiss Brain Institute
University of Calgary, Cumming School of Medicine
Calgary, Canada

Medical Research: What is the background for this study? What are the main findings?

Dr. Hill: ESCAPE examine endovascular therapy for major acute ischemic stroke.

The study found that among acute stroke patients with proximal occlusions (blocked ICA or MCA), good collaterals and fast endovascular treatment, there was a substantial reduction in morbidity (24% absolute reduction) and in mortality (a 9% absolute and 50% relative reduction in death).

Medical Research: What should clinicians and patients take away from your report?

Dr. Hill: The finding are a major and compelling validation of endovascular treatment of major ischemic stroke.  In combination with results from other studies – MRCLEAN, SWIFT-prime, EXTEND-IA, we believe that the standard of care for major acute ischemic stroke has been definitively changed.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Hill: We must remember that there were still 47% of patients who did not have an independent functional outcome and 10% who died.  This means that there is still lots of work to do to improve outcomes in those patents.

A key thing to do next is to work hard on how to implement this therapy.  It takes tremendous teamwork, fast workflow, attention to imaging plus good technique and use of novel technology to make this work and work well.

The key messages from ESCAPE are:

  • Select patients with imaging – measure the physiology – www.aspectsinstroke.com
  • Good scan (exclude the large core patients), proximal artery occlusion, moderate-good collaterals on mCTA
  • Act very fast on that information
    • Picture-to-puncture (First slice CTgroin puncture) < 60 minutes
    • Picture-to-perfusion (First slice CTreperfusion) < 90 minutes
  • Achieve reperfusion – TICI 2b/3
  • Work as a team!
  • NNT = 3 if you do this.

Citation:

Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times (ESCAPE)
Bruce C.V. Campbell, M.D., Peter J. Mitchell, M.D., Timothy J. Kleinig, M.D., Helen M. Dewey, M.D., Leonid Churilov, Ph.D., Nawaf Yassi, M.D., Bernard Yan, M.D., Richard J. Dowling, M.D., Mark W. Parsons, M.D., Thomas J. Oxley, M.D., Teddy Y. Wu, M.D., Mark Brooks, M.D., Marion A. Simpson, M.D., Ferdinand Miteff, M.D., Christopher R. Levi, M.D., Martin Krause, M.D., Timothy J. Harrington, M.D., Kenneth C. Faulder, M.D., Brendan S. Steinfort, M.D., Miriam Priglinger, M.D., Timothy Ang, M.D., Rebecca Scroop, M.D., P. Alan Barber, M.D., Ben McGuinness, M.D., Tissa Wijeratne, M.D., Thanh G. Phan, M.D., Winston Chong, M.D., Ronil V. Chandra, M.D., Christopher F. Bladin, M.D., Monica Badve, M.D., Henry Rice, M.D., Laetitia de Villiers, M.D., Henry Ma, M.D., Patricia M. Desmond, M.D., Geoffrey A. Donnan, M.D., and Stephen M. Davis, M.D. for the EXTEND-IA Investigators

February 11, 2015DOI: 10.1056/NEJMoa1414792

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MedicalResearch.com Interview with: Michael D Hill, MD MSc FRCPC (2015). Endovascular Therapy Improves Outcomes In Acute Ischemic Stroke MedicalResearch.com

Last Updated on February 15, 2015 by Marie Benz MD FAAD

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