Royal College of Surgeons in Ireland: Researchers from RCSI (Royal College of
Surgeons in Ireland) and Beaumont Hospital have taken part in a major
international study which is set to revolutionise the treatment of
stroke. The study has shown that a clot retrieval procedure, known as
endovascular treatment (ET) results in a dramatic improvement in patient
outcomes and a reduction in disability and deaths from stroke. The
results of this study are published today in the online edition of the
New England Journal of Medicine.
The international randomised controlled trial which was led by
researchers at the University of Calgary's Hotchkiss Brain Institute
(HBI) was carried out at 22 sites worldwide and included patients
referred to Beaumont Hospital in Dublin from ten centres across Ireland
and from hospitals in Canada, the US, UK and South Korea. The study
involved patients who had suffered an acute ischemic stroke, which is
caused by a clot in the brain, and accounts for 80 per cent of all
strokes.
Overall, positive outcomes for patients receiving the new ‘clot removal'
treatment 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 by 50 per
cent, from two in ten patients for standard treatment of care, to one in
ten patients out of those who received the new treatment. Up to now,
the current standard treatment involved administering medication to
dissolve the clot.
Professor David Williams, Associate Professor in Geriatric and Stroke
Medicine, RCSI and Consultant Stroke Physician at Beaumont Hospital and
Dr John Thornton, Consultant Neuroradiologist, at Beaumont Hospital were
the co-leads in Ireland for the study.
"The results of this study represent the most significant development in
stroke treatment in the past 20 years and will impact stroke care in
Ireland and around the world. More than 10,000 people in Ireland are
admitted to hospital with stroke annually and many of those who survive
are left with significant disabilities. This treatment has the potential
to improve survival rates and quality of life of more than 15 million
people worldwide who suffer a stroke each year. The involvement of RCSI
and Beaumont Hospital in this ground-breaking trial demonstrates the
world-class expertise of clinical researchers here in Ireland,"
Professor Williams said.
While the new treatment is improving outcomes, it is still vital that
the warning signs of stroke are identified as quickly as possible.
"When removing a clot with this new treatment, as with existing
treatments, every minute matters. If you suspect someone is having a
stroke, call 999 immediately as many stroke treatments only work if
administered within a set period of time. The tell-tale signs of stroke
are facial drooping, inability to raise arms over their heads and
slurred speech," Professor Williams concluded.
Beaumont Hospital was the largest patient recruiting site for the study
outside Canada with 34 patients taking part in the randomised trial over
6 months, recruited by the research team at Beaumont Hospital and
followed up by expert research nurses at the RCSI Clinical Research
Centre based at Beaumont Hospital.
"There was impressive collaboration between stroke centres; doctors and
nurses; and transport services as well as the radiology team in Beaumont
where all the procedures were performed,' commented Dr John Thornton.
According to the Irish Heart Foundation, stroke kills more than 2,000
people a year in Ireland - a higher death toll than from breast cancer,
prostate cancer and bowel cancer combined. Stroke is the third most
common cause of death and the most common cause of acquired physical
disability in Ireland. There are more than 30,000 survivors of stroke in
Ireland, many of whom have significant disabilities.
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 ET 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 European and North American guidelines is to administer a
drug called tPA when appropriate to bring on a process of thrombolysis.
Known as a ‘clot buster', the drug dissolves the blood clot. In the
ESCAPE trial, 316 patients who fit the criteria for ET and arrived for
treatment within 12 hours of their stroke were randomised to standard
medical care (which included the clot-busting drug tPA where
appropriate) or standard medical care plus ET.
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 ET has
only recently been technically possible. The success of the ESCAPE 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 ET 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.
The study was funded by The Heart and Stroke Foundation of Canada,
Alberta Innovates-Health Solutions and Medtronic, along with generous
donations to the HBI Stroke Team and the Calgary Stroke Program.
RCSI is the academic partner in RCSI Hospitals Group, which includes
Beaumont, Cavan and Monaghan, Connolly, Louth County, Our Lady of
Lourdes Drogheda and Rotunda Hospitals.
RCSI is among the top 50 most international universities in the world
(Times Higher Education University World Rankings, 2014-15). It is a
not-for-profit health sciences institute focused on education and
research to drive positive change in all areas of human health
worldwide. RCSI is headquartered in Dublin and is a recognised College
of the National University of Ireland. In 2010, RCSI was granted
independent degree awarding status by the State, which enables the
College to award degrees alongside its traditional powers to award
licentiates.
Beaumont Hospital is a large academic teaching hospital 5km north of
Dublin City centre. The hospital provides emergency and acute care
services across 54 medical specialties to a local community of some
290,000 people as well as servicing over 45,000 patients each year in
the ED. In addition, Beaumont Hospital is a Designated Cancer Centre and
the Regional Treatment Centre for Ear, Nose and Throat, and
Gastroenterology. The hospital also acts as the National Referral Centre
for Neurosurgery and Neurology, Renal Transplantation, and Cochlear
Implantation.
Beaumont Hospital is the principal teaching hospital for the Royal
College of Surgeons in Ireland as well as partnerships with Dublin City
University, especially in the area of nurse training, and with other
academic institutions in respect of training and research.