ISC.15: Functional stroke outcomes improved by rapid endovascular treatment

For some patients with acute ischemic stroke, rapid endovascular treatment may offer improved outcomes, according to findings presented Feb. 11 at the American Stroke Association’s 2015 International Stroke Conference (ISC) in Nashville, Tenn.

Mayank Goyal, MD, of Hotchkiss Brain Institute at the University of Calgary in Alberta, Canada, presented the findings from the ESCAPE (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times) trial during the late-breaking trials session on behalf of his colleagues.

The ESCAPE trial enrolled 316 patients at 22 centers worldwide. Patient assessment was done using CT or CT angiography. Those with good collateral circulation, occluded proximal artery in the anterior circulation and small infarct core were enrolled. Patients were randomized to receive standard care or standard care plus rapid endovascular treatment with thrombectomy devices, including retrieval stents and balloon guide catheter. Median time from symptom onset to first reperfusion was 241 minutes.

An interim analysis was conducted shortly after results were published from another trial proving the efficacy of the method. Analysis concluded that efficacy boundaries had been crossed in ESCAPE as well and the study was terminated early.

Odds of patients improving by one point on a modified Rankin scale were 2.6 in favor of the intervention. The intervention group also saw 53 percent of patients with a modified Rankin score of two or less at 90 days compared to 29.3 percent of control patients. Fewer patients died at 90 days in the intervention group (10.4 percent) as opposed to the control group (19 percent).

Symptomatic intracerebral hemorrhage rates were higher among patients in the intervention as opposed to those receiving standard care (3.6 percent vs. 2.7 percent, respectively). Measures investigating quality of life and function in patients significantly favored the intervention group.

In the article simultaneously published in the New England Journal of Medicine, Goyal et al wrote that their findings confirm reports from the recently published MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) trial. They also noted that ESCAPE improved on those findings by using imaging to focus on patients with small infarct cores and better circulation as well as shorter symptom-onset-to-treatment intervals and lower rates of general anesthesia.

“[T]he ESCAPE trial, in which fast and efficient workflow, innovative imaging, and effective thrombectomy devices were used, provides evidence of the benefit of endovascular treatment in patients with moderate-to-severe ischemic stroke,” they wrote.