ESCAPE: Rapid endovascular treatment improved function, survival in ischemic stroke

NASHVILLE, Tenn. — Rapid endovascular treatment was associated with reduced mortality and improved functional outcomes in imaging-selected patients with major ischemic stroke, researchers reported at the International Stroke Conference.

According to results from the ESCAPE trial, patients with acute ischemic stroke who had a proximal vessel occlusion, a small infarct core and moderate-to-good collateral circulation benefited from rapid endovascular treatment.

“The study will change the way major ischemic stroke is managed,” Michael D. Hill, MD, MSc, FRCPC, from the Calgary Stroke Program of the department of clinical neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada, told Cardiology Today. “It is a great boon to patients and a game changer in the way stroke is treated.”

Despite alteplase treatment, 60% to 80% of patients with a proximal vessel occlusion in the anterior circulation die within 90 days of stroke onset or do not regain functional independence, according to the study background.

Hill and colleagues randomly assigned 316 participants at 22 international centers to receive standard care or standard care plus use of available thrombectomy devices. The primary outcome was modified Rankin scale score at 90 days. The researchers also calculated a common OR to measure the likelihood that thrombectomy would lead to lower scores on the modified Rankin scale than standard care alone.

Hill and colleagues reported that the ESCAPE trial was stopped early because of efficacy.

Of the 316 participants enrolled, 238 (intervention group, 120; control group, 118) received alteplase. In the intervention group, median time from study CT of the head to reperfusion was 84 minutes, according to the researchers.

The intervention group had a greater rate of functional independence, defined as modified Rankin score of 0 to 2 at 90 days vs. controls (53% vs. 29.3%; P < .001).

The primary outcome favored thrombectomy (common OR = 2.6; 95% CI, 1.7-3.8) and the intervention also was associated with reduced mortality (intervention group, 10.4%; control group, 19%; P = .04).

The researchers observed no differences between the groups in symptomatic intracerebral hemorrhage (treatment group, 3.6%; control group, 2.7%; P = .75). – by Erik Swain

References:

Goyal M, et al. N Engl J Med. 2015;doi:10.1056/NEJMoa1414905.

Hill MD. Plenary Session I: LB1. Presented at: International Stroke Conference; Feb. 11-13, 2015; Nashville, Tenn.

Disclosure: The study was funded in part by Covidien. Hill reports receiving grant support from Covidien and several noncommercial entities during the conduct of the study; personal fees from Merck and nonfinancial support from Hoffmann-La Roche not related to the study; holding a pending patent related to systems and methods to assist decision-making and triaging for patients with acute stroke; and owning stock in Calgary Scientific Inc.