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Studies validate treatment for stroke patients

The results of three key studies have validated a stroke treatment that The University of Toledo Medical Center was the first to offer the region and is a leader in delivering the care.

The studies that compared mechanical thrombectomy — removing a blood clot with a stent-like device — versus conventional medicinal therapy to break up the clot were recently presented at the American Stroke Association International Stroke Conference in Nashville. The studies showed the treatment as a clear success; one found the death rate cut almost in half for patients who received the treatment.

The mechanical thrombectomy technique was first performed in the Toledo region by UTMC’s Dr. Mouhammad A. Jumaa and Dr. Syed F. Zaidi, vascular and interventional neurologists and assistant professors of neurology.

“We have been offering this endovascular stroke treatment at UTMC since 2012. It is indeed reassuring that our approach has been conclusively validated by these large studies,” Zaidi said. “We have impacted many lives in the greater northwest Ohio region and hope that through further media awareness, more patients will get a chance for a better outcome when faced with this devastating disease.”

“There is a limited time window to re-establish blood flow to the brain before a stroke is completed,” Jumaa said. “With this level of evidence, it is now critical to transport patients quickly to the nearest center where this treatment can be offered.”

Strokes, affecting about 800,000 people in the United States each year, are caused by a blood clot lodged in the brain. The traditional treatment has been administering the clot-dissolving medication tPA. The mechanical thrombectomy technique instead uses a metal mesh cage called a stent retriever that essentially flattens the clot, traps it and removes it, opening the artery faster and with less damage.

“Mechanical thrombectomy will become the standard of care for acute stroke therapy in patients with moderate to severe stroke who do not qualify or do not benefit from the conventional clot busting medication tPA,” said Dr. Gretchen Tietjen, the UT Clair Martig Endowed Chair in Neurology.

The three recent studies — SWIFT PRIME, EXTEND-IA and ESCAPE — confirmed the findings of the previous Multi-center Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) study published in The New England Journal of Medicine in December.

ESCAPE, a Canadian study, assessed 316 patients and found that the addition of intervention — recommended with the often-used Solitaire stent — doubled patients’ rates of return to functional independence and cut the risk of death from stroke in half compared to traditional treatment with tPA alone. Functional independence also was significantly improved at 90 days.

Similarly, EXTEND-IA, which was conducted in Australia and included 70 patients, also found that the addition of Solitaire stents doubled patients’ rates of return to functional independence compared to treatment with tPA alone. Functional independence also was significantly improved from 29 percent to 53 percent.

The EXTEND-IA study showed a strong trend toward reduction in death from stroke, reducing the mortality rate from 20 percent to 9 percent. Patients treated with Solitaire also spent significantly less time in the hospital or in rehabilitation before returning home or to work in 15 days compared to 73 days.

The Canadian and Australian studies were published recently in The New England Journal of Medicine.

SWIFT PRIME, which was conducted in 39 hospitals in North America and Europe and assessed the use of the Solitaire device in addition to tPA versus tPA treatment alone, also was presented at the conference, but has not yet been published.

The study enrolled 196 patients and showed a statistically significant improvement in 90-day functional outcome for patients receiving Solitaire stent thrombectomy rather than tPA alone.

For more information on UTMC’s Stroke Program, click here.

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