Department of Clinical Neurosciences
The Calgary Stroke Program’s ESCAPE trial results were published in the New England Journal of Medicine Feb. 11, 2015, at the same time as the team presented their findings to the International Stroke Conference in Nashville, TN.
The randomized clinical trial, which compared traditional ischemic stroke treatment to an innovative endovascular therapy, was lead by principal investigators Drs. Michael Hill, Mayank Goyal and Andrew Demchuk.
By implementing the new endovascular therapy, which involved rapid brain imaging, an innovative treatment workflow and novel technology to open up the artery, researchers found the number of patients able to return to independent living jumped to 55 per cent from 30 per cent in the control group.
“What this trial has shown is that, using the procedure to open up the vessel — to go into the blood vessel and pull the clot out—is dramatically beneficial,” said Dr. Goyal.
“One of the things that we say is ‘Time is Brain’. So in a person who is suffering from blockage of the blood vessel, brain cells are dying. And the only way to stop the brain cells from dying is to open the vessel,” he said.
Mortality rates in the ESCAPE trial also dropped from 20 per cent to 10 per cent with the therapy and results were equally beneficial among men and women.
“We found that even patients over the age of 80—the oldest person treated within the trial was 93—showed benefit,” said Dr. Goyal.
“Many more patients came back to normal—to independent living; to living with their families.”
An ischemic stroke occurs when one of the blood vessels that supply blood to the brain is blocked by a clot. Traditionally, clot-busting drugs are used to treat patients.
The Calgary-based ESCAPE trial, which included sites across Canada, the U.S., South Korea and Europe, used a stent to retrieve the clot and developed entirely new processes to allow for rapid patient imaging and preparation for the procedure.
“Stroke care is going to have to change a lot because the whole process of treating patients with this therapy requires tremendous organization,” said Dr. Hill.
“It requires careful attention to imaging of the brain, and substantial teamwork and parallel processing of workflow.”
Calgary patients selected for the trial were treated at Foothills Hospital and first underwent imaging to determine where the clot was in the brain. Patients were then quickly prepared for the clot-removal procedure, said Dr. Goyal.
“You go in from the groin and put a tiny tube in which, under X-ray guidance, you can move right through the body into the vessels of the neck and through this tube you put an even tinier tube—around one mm in size,” he said.
“Under X-ray guidance we take it right to the level of the clot, deploy a retrievable stent, capture the clot and pull it out of the body.”
The results were so successful that the trial was stopped for efficacy.
“When you pull it out, there's restoration of blood flow to the brain and, so to speak, the brain becomes ‘happy’ again.”
The stroke team at Foothills Hospital—part of the Department of Clinical Neurosciences (DCNS)—is a world-leader in stroke care and spent about nine months designing the trial, said Dr. Demchuk.
“Calgary is unique because we have a very large number of stroke academicians and it crosses multiple disciplines and training experiences,” he said.
“For example, it has physiatry, neurology, neurosurgery as well as neuroradiology. We have imaging expertise and methodology expertise and trial expertise so it comes together to make something like this happen,” he said.
“Around the world, this is extremely rare – to have all these components. Without DCNS, this group wouldn't have come together.”
With the release of the results in the prestigious New England Journal of Medicine, Dr. Goyal said the next step is to share the results and help other stroke programs implement the new therapy.
“We need to change guidelines, we need to create the infrastructure and we need to make sure we're able to implement in a fashion that we are able to replicate the results of this trial all across the world,” he said.
“But, to my mind, clearly now there is sufficient evidence to say that this is how it should be done.”
Read the New England Journal of Medicine article
Visit the ESCAPE web site here
CTV Calgary: New therapy improves end results for stroke patients
The Globe and Mail: New procedure a ‘major breakthrough’ in stroke treatment: Canadian study
RTE (Ireland): New breakthrough in stroke treatment
The Guardian (UK): Stroke treatment improves patients' chances of avoiding brain damage
Pittsburgh Tribute: New stroke treatment could reduce number of deaths
DCNS annual report highlights "Innovation Through Collaboration"
It is available in PDF form by clicking here.
The report summarizes the work of our four divisions over the past year: Neurology; Neurosurgery; Physical Medicine & Rehabilitation; and Translational Neuroscience.
It contains a summary of all our programs and clinics, lists our grant and publication successes, and tells the story of some of our patients — individuals who inspire us daily.
If you would like a hardcopy, please contact the DCNS administration office or click here to send an email request.
The Department of Clinical Neurosciences would like to congratulate Dr. Bijoy Menon on his recent Top 40 Under 40 award.
Dr. Menon's research and teaching in the area of stroke was recognized by Avenue Magazine along with three others from the Cumming School of Medicine.
The neurologist studies stroke imaging and vascular and degenerative dementia.
Click here for the full story.
The Department of Clinical Neurosciences is currently recruiting for the following positions:
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