Endovascular Clinical Trials
That Proved the Efficacy of Mechanical Thrombectomy for the Treatment of Acute Stroke
and Changed the Standard of Care for Patients Worldwide
Easily Applicable
Based on the Plain/Non-contrast CT Head. The ASPECT Score can be used to assess early ischemic changes in acute stroke on any modern CT scanner without the need for additional processing steps making it easily applicable in many settings worldwide.
Imaging Based
As the initial imaging modality to both screen for and establish the diagnosis of acute stroke, the ASPECT Score provides an opportunity to quantify the degree of ischemic changes in the brain parenchyma and serve as the basis for subsequent decision making.
Easily Communicated
A score out of 10, the ASPECT Score is an easy and widely understood means of communicating the extent of ischemic changes amongst care teams and physicians.
The ESCAPE TRIAL:
Canadian researchers have completed an international randomized controlled trial showing that a clot retrieval procedure, known as endovascular treatment (EVT), can dramatically improve patient outcomes after an acute ischemic stroke. The study, led by researchers at the University of Calgary’s Hotchkiss Brain Institute (HBI), shows a dramatic improvement in outcomes and a reduction in deaths from stroke. The results of this study were published in the Feb. 11 online edition of the New England Journal of Medicine (NEJM).
Overall, positive outcomes for patients increased from 30 per cent to 55 per cent. In many cases, instead of suffering major neurological disability, patients went home to resume their lives. The overall mortality rate was reduced from two in 10 patients for standard treatment of care to one in 10 patients – a 50 per cent reduction with EVT.
The clinical trial, known as ESCAPE (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times), shows there is a marked reduction in both disability and death among patients who receive EVT for acute ischemic stroke. Ischemic stroke is caused by a sudden blockage of an artery to the brain that deprives the brain of critical nutrients, such as glucose and oxygen. Currently, the international standard of care based on Canadian, U.S. and European guidelines is to administer a drug called tPA when appropriate. Known as a ‘clot buster’, the drug dissolves the blood clot.
In the ESCAPE trial, 316 patients who fit the criteria for EVT and arrived for treatment within 12 hours of their stroke were randomized to standard medical care (which included the clot-busting drug tPA where appropriate) or standard medical care plus EVT.
ET 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.
Endovascular treatments were first developed in the 1990s, but EVT has only recently been technically possible. The ESCAPE team says the success of the trial can be credited to very fast treatment and the use of brain and blood vessel imaging. In ESCAPE, researchers were on average two hours faster in opening the blocked blood vessels than in previously reported trials.
ESCAPE is the second EVT trial that demonstrates the efficacy of the treatment and the first trial to demonstrate reduced mortality. The previous trial, known as MR. CLEAN (Multi center Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands), was published in December 2014.
ESCAPE TRIAL Sites:
The study included 22 sites worldwide and patients in the U.S., U.K., Ireland and South Korea. Canada had 11 participating hospitals and enrolled two-thirds of the patients.
Foothills Medical Centre | Calgary, Alta.
Royal University Hospital | Saskatoon, Sask.
Colorado Neurological Institute | Denver, Colo.
St. Michael's Hospital | Toronto, Ont.
UPMC Medical Centre | Pittsburgh, Penn.
Queen Elizabeth II HSC | Halifax, N.S.
Toronto Western Hospital | Toronto, Ont.
University of Alberta Hospital | Edmonton, Alta.
Chattanooga Center for Neurologic Research | Chattanooga, Tenn.
CHUM-Hospital Notre-Dame | Montreal, Que.
MUSC-Medical University of South Carolina | Charleston, S.C.
Sunnybrook Health Sciences Centre | Toronto, Ont.
Ottawa Hospital | Ottawa, Ont.
London Health Sciences Centre | London, Ont.
McGill University (MNI) | Montreal, Que.
Beaumont Hospital | Dublin, Ireland
Abington Memorial Hospital | Abington, Penn.
Royal Victoria Hospital | Belfast, N. Ireland
Yonsei University (Severance Hospital) | Seoul, South Korea
Samsung Medical Centre | Seoul, South Korea
Keimyung University (Dongsan Medical Centre) | Daegu, South Korea
Temple University Hospital | Philadelphia, Penn.
ASPECTS and mCTA Score Advantages
Here are some highlights as to what makes the ASPECT score reliable and applicable!
