Three new clinical trials have provided strong support for the use of interventional embolectomy as a life-saving measure for patients suffering a stroke. This minimally invasive procedure, in which interventional neuroradiologists mechanically remove a stroke-causing clot, had been considered experimental until now, but results of three major trials announced at the 2015 International Stroke Conference may herald a new age of treatment for ischemic stroke.
The three trials (known as MR CLEAN, EXTEND-IA, and ESCAPE) all showed better outcomes for patients treated with interventional embolectomy than those treated with “clot-busting” drugs alone, which is the current standard of care. In fact, the EXTEND-IA and ESCAPE studies were halted early after initial results so clearly showed better outcomes in the intervention group.
Results of the MR CLEAN study ((Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands) were announced at the World Stroke Congress in October, followed by the November announcement that two additional trials — ESCAPE (Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke) and EXTEND IA (Extending the Time for Thrombolysis in Emergency Neurological Deficits - Intra-Arterial) — would be halted based on early results. The data safety monitoring committee of a fourth study — the SWIFT PRIME (Solitaire FR as Primary Treatment for Acute Ischemic Stroke) study — then recommended that that trial also be halted early.
Earlier trials, using first-generation embolectomy equipment, had failed to show benefits over clot-busting drugs. The second-generation devices, used in the right patients, were shown to be more effective at removing clots with fewer injuries to the blood vessels than with the earlier devices.
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