Authors

Mayank Goyal, University of Calgary
Andrew M. Demchuk, Dresden University
Bijoy K. Menon, University of Calgary
Muneer Eesa, University of Calgary
Jeremy L. Rempel, University of Alberta
John Thornton, Royal College of Surgeons in IrelandFollow
Daniel Roy, Centre Hospitalier de L'Universite de Montreal
Tudor G. Jovin, University of Pittsburgh
Robert A Willinsky, University of Calgary
Biggya L. Sapkota, Erlanger Medical Centre, Chattanooga
Dar Dowlatshahi, University of Ottawa
Donald F. Frei, Swedish Medical Center, Colorado
Noreen R. Kamal, University of Calgary
Walter J. Montanera, University of Calgary
Alexandre Y. Poppe, University of Montreal
Karla J. Ryckborst, University of Calgary
Frank L. Silver, University of Toronto
Ashfaq Shuaib, University of Alberta
Donatella Tampieri, McGill University
David Williams, Royal College of Surgeons in IrelandFollow
Oh Young Bang, SungKyunKwan University
Blaise W. Baxter, Erlanger Medical Centre, Chattanooga
Paul A. Burns, Royal Victoria Hospital Belfast
Hana Choe, Abington Memorial Hospital, Abington
Ji-Hoe Heo, Yonsei University
Christine A. Holmstedt, University of South Carolina
Brian Jankowitz, University of Pittsburgh Medical Center
Michael Kelly, Connolly Hospital Blanchardstown
Guillermo Linares, University of Vermont
Jennifer L. Mandzia, Western University, Canada
Jai Shankar, Dalhousie University
Sung-Il Sohn, Keimyung University
Richard H. Swartz, University of Toronto
Philip A. Barber, University of Calgary
Shelagh B. Coutts, University of Calgary
Eric E. Smith, University of Calgary
William F. Morrish, University of Calgary
Alain Weill, Caisse Nationale de l'assurance Maladie des Travailleurs Salariés
Suresh Subramaniam, University of Calgary
Alim P. Mitha, University of Calgary
John H. Wong, University of Calgary
Mark W. Lowerison, University of Calgary
Tolulope T. Sajobi, University of Calgary
Michael D. Hill, University of Calgary

Peer Reviewed

1

Document Type

Article

Publication Date

11-2-2015

Keywords

Randomized Assessment, Rapid Endovascular Treatment, Ischemic Stroke

Funder/Sponsor

The Heart and Stroke Foundation of Canada, Alberta Innovates-Health Solutions and Medtronic, HBI Stroke Team, Calgary Stroke Program

Comments

The original article is available at http://www.nejm.org/doi/full/10.1056/NEJMoa1414905

Abstract

Background Among patients with a proximal vessel occlusion in the anterior circulation, 60 to 80% of patients die within 90 days after stroke onset or do not regain functional independence despite alteplase treatment. We evaluated rapid endovascular treatment in addition to standard care in patients with acute ischemic stroke with a small infarct core, a proximal intracranial arterial occlusion, and moderate-to-good collateral circulation.

Methods We randomly assigned participants to receive standard care (control group) or standard care plus endovascular treatment with the use of available thrombectomy devices (intervention group). Patients with a proximal intracranial occlusion in the anterior circulation were included up to 12 hours after symptom onset. Patients with a large infarct core or poor collateral circulation on computed tomography (CT) and CT angiography were excluded. Workflow times were measured against predetermined targets. The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. A proportional odds model was used to calculate the common odds ratio as a measure of the likelihood that the intervention would lead to lower scores on the modified Rankin scale than would control care (shift analysis).

Results The trial was stopped early because of efficacy. At 22 centers worldwide, 316 participants were enrolled, of whom 238 received intravenous alteplase (120 in the intervention group and 118 in the control group). In the intervention group, the median time from study CT of the head to first reperfusion was 84 minutes. The rate of functional independence (90-day modified Rankin score of 0 to 2) was increased with the intervention (53.0%, vs. 29.3% in the control group; P

Disciplines

Geriatrics | Medicine and Health Sciences

Citation

Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD; the ESCAPE Trial Investigators. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. New England Journal of Medicine. 2015;372(11):1019-30

PubMed ID

25671798

DOI Link

10.1056/NEJMoa1414905

Creative Commons License

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This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

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