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Early treatment leads to less disability following stroke

New ‘ESCAPE’ procedure shown to benefit patients most within two hours of symptom onset

University of Calgary researchers, from left, Dr. Mayank Goyal, Dr. Andrew Demchuk and Dr. Michael Hill in the neuro-angiography suite where endovascular treatment is performed.

Photo by Riley Brandt, University of Calgary

A recent clinical trial led by the Hotchkiss Brain Institute (HBI) at the University of Calgary’s Cumming School of Medicine was one of five international trials that showed a blood clot retrieval procedure, known as endovascular treatment (EVT), can dramatically improve patient outcomes after an acute ischemic stroke. Figures from this study, known as ESCAPE (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times), have now been published as part of a meta-analysis where researchers analyzed the ideal amount of time in which the procedure along with a clot-busting drug should be performed for maximum benefit.  The results were published in the September issue of the Journal of the American Medical Association.

Researchers analyzed data from nearly 1,300 patients at 89 international sites and found that compared with medical therapy alone (dispensing a clot-busting drug), earlier treatment with EVT plus the clot-busting drug was associated with lower degrees of disability at three months. Benefit was greatest to patients who received surgery within two hours of symptom onset and treatment became nonsignificant after 7.3 hours.

“Time is brain. This study shows that the faster physicians can administer treatment, the better outcome for patients. It is critical that patients recognize the signs of stroke and seek treatment immediately,” says Dr. Mayank Goyal, who is an author on the ESCAPE study and the JAMA publication. “This study further reinforces the need for organization of stroke systems of care all the way from the first medical contact to reaching the correct hospital, efficient diagnostics and finally opening the occluded the vessel.”

Endovascular therapy 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.

“In the last year, endovascular therapy has already become the standard of care at many hospitals. It is the most significant and fundamental change in acute ischemic stroke treatment in the last 20 years,” says Dr. Michael Hill, also an author on both studies. 

The paper was co-authored by an international team of doctors and scientists including Dr. Hill, Dr. Goyal, Dr. Andrew Demchuk, Dr. Bijoy Menon, all from the university’s HBI, as well as Dr. Jeffrey Saver, professor of neurology, David Geffen School of Medicine at UCLA and director, UCLA Comprehensive Stroke Center.

Led by the HBI, Brain and Mental Health is one of six strategic research themes guiding the University of Calgary towards its Eyes High goals.

Dr. Mayank Goyal is a professor in the Department of Radiology at the University of Calgary’s Cumming School of Medicine. He is also a member of the HBI, and director of imaging and intervention, Calgary Stroke Program, Alberta Health Services.

Dr. Michael Hill is a professor in the departments of Clinical Neurosciences, Community Health Sciences, Medicine and Radiology at the University of Calgary’s Cumming School of Medicine. He is also a member of HBI and director of the Stroke Unit for the Calgary Stroke Program, Alberta Health Services.