Clot Removal Dramatically Improves Stroke Outcomes

Researchers at the UCLA Stroke Center (Los Angeles, CA, USA), University Hospital Essen (Germany), and 37 other institutions randomly assigned 196 eligible patients with stroke who were receiving or had received intravenous tissue plasminogen activator (t-PA) to continue with t-PA alone (control group, 98 patients) or to undergo endovascular thrombectomy with a stent retriever within six hours after symptom onset (intervention group, 96 patients). The primary outcome was the severity of global disability at 90 days on the modified Rankin scale.

The study, which was stopped early due to efficacy, showed that in the intervention group the rate of substantial reperfusion at the end of the procedure was 88%, compared to 25%–30% in the control group. Thrombectomy with the stent retriever plus intravenous t-PA also reduced disability at 90 days over the entire range of scores on the modified Rankin scale. Functional independence was higher in the intervention group (60%) than in the control group (35%). There were no significant differences in mortality or symptomatic intracranial hemorrhage. The study was published on April 17, 2015, in the New England Journal of Medicine (NEJM).

“We are very happy to see this decade-long research program result in an important advance for stroke patients. These findings are a paradigm shift — a new era in stroke care — and we are ecstatic,” said global lead author Prof. Jeffrey Saver, MD, director of the UCLA Stroke Center. “We will be able to treat many more patients, who will have much better outcomes. This is a once-in-a-generation advance in acute stroke care.”

“While this won’t help all stroke patients, the ones it will help have the most disabling strokes,” said study coauthor Sidney Starkman, MD, co-director of the UCLA Stroke Center. “Right now, they get t-PA and it helps a third of them, but the other two-thirds end up dependent on others for help or they die.”

For the study, the researchers used the Covidien (Dublin, Ireland) Solitaire FR revascularization device, a mechanical catheter-based thrombectomy system that combines the ability to restore blood flow, administer medical therapy, and retrieve clot in patients experiencing acute ischemic stroke.

Related Links:
UCLA Stroke Center
University Hospital Essen
Covidien