Endovascular Therapy–New Hope for Severe Stroke Patients
The results of four new studies may signal a major advancement in the treatment of acute ischemic stroke. The studies – MR CLEAN, ESCAPE, EXTENDIA, and SWIFT PRIME, all show dramatically positive results of endovascular therapy in treating the disease.
The new research reverses findings that failed to show any benefit from endovascular therapy that was previously presented at the International Stroke Conference (ISC) two years ago (IMSIII, SYNTHESIS EXPANSION, and MR RESCUE).
More Urgency Could Mean Less Disability
The studies each show that removing the clot with the latest stent retriever technology in a timely fashion led to less disability and a greatly improved chance of a good functional outcome. The number needed to treat (NNT) for one additional person to achieve a good outcome (modified Rankin Scale score of 0 to 2) was 4 in the ESCAPE and SWIFTPRIME studies and 3.2 in EXTENDIA. The MR CLEAN authors have not formally reported NNT figures, but lead investigator Yvo Roos, MD, Academic Medical Center, Amsterdam, the Netherlands, told Medscape Medical News that their equivalent NNT estimate was 7.4.
Medscape.com also quotes ISC program chair Kyra Becker, MD, who cautions that these new positive results apply only to a small percentage of all stroke patients: those with a major cerebral vessel occlusion. "But these are the patients who do the worst and this treatment will make a big difference to them. They also need to be treated very fast," she added. "Time is always critical in stroke care, but now for these patients with these big strokes, it is especially important to get help quickly."
Different Studies but the Same Finding
While the studies all had similar designs–they each specified that patients must have an ischemic stroke with an occlusion of a major cerebral artery identified by imaging–there were also differences. MR CLEAN had the most pragmatic design with Computed tomographic (CT) Angiography to identify the clot as the only imaging used after the regular CT scan to rule out hemorrhagic stroke. The other three trials included more sophisticated imaging techniques to identify patients who still had large areas of salvageable brain tissue.
Despite their differences, each study provides overwhelming evidence of a major advancement in stroke treatment. Dr. Allan Brook and Dr David Gordon, Co-Directors of Montefiore's Center for Cerebrovascular Surgery, note that, "All the studies are highlighting the same finding that if we can select the correct candidate using imaging, the latest endovascular treatments can open the blocked artery and produce a good outcome."
Around the Clock Treatment Availability is Key
In order for these new therapies to be made accessible to more patients, Mescape.com reports, stroke needs to be treated more often as the medical emergency that it is. To be successful, stroke patients suspected of having a major artery occlusion need to be urgently directed to hospitals with the appropriate facilities and on duty stroke teams. Physicians need to recognize that 24/7 fast treatment is key to a good recovery.
Montefiore has the appropriate resources to handle these cases in the Bronx and lower Westchester County.
For more information on our neuro-interventional team and how we can provide 24/7 coverage to augment your facility's Stroke care, please call Teshana Barrett, 718-920-4216, to setup an informational meeting with our team of physicians.