2015 Late-Breaking Science Summaries
Plenary Session I
Embargoed for 11 a.m. CT, Wednesday, Feb. 11, 2015
Presented from 11:10 am CT – noon CT, Wednesday, February 11, in Hall B
LB 1 Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with
Emphasis on minimizing CT to recanalization times (ESCAPE)
Endovascular therapy with careful imaging selection, very fast treatment and high reperfusion rates
may significantly benefit stroke patients, according to a small Canadian study reported at the American
Stroke Association’s International Stroke Conference 2015.
There are conflicting data on whether clot removal devices (endovascular therapies) are better than
routine treatment for acute ischemic stroke. There is evidence that endovascular therapy can result in
faster, more complete restoration of blood flow to the brain, which should result in better outcomes.
In this phase 3, randomized, controlled trial called ESCAPE, researchers enrolled 315 patients.
They were randomized to standard medical care (which included the clot-busting drug tPA where
appropriate) or standard medical care plus endovascular intervention.
Imaging tests indicated that the selected patients had minimal early stroke damage, blocked arteries
and good collateral circulation. Endovascular treatment was very fast with blood flow restored (using
modern devices; primarily stent retrievers) on average in less than 90 minutes of a CT scan.
The trial was halted in November 2014 after an interim analysis revealed that the study had crossed
a pre-planned overwhelming efficacy boundary. Final results will be presented at the meeting.
Michael D. Hill, M.D., M.Sc. Professor, Dept. Clinical Neurosciences, University of Calgary, Canada;
LB 2 EXTEND-IA - Endovascular Therapy After Intravenous t-PA Versus t-PA Alone For Ischemic
Stroke Using CT Perfusion Imaging Selection
Early endovascular clot retrieval after Tissue plasminogen activator (tPA) resulted in greater reperfusion
and early neurologic recovery than tPA alone in a population with major arterial occlusion and salvageable
tissue on CT perfusion imaging, according to an Australian study reported at the American Stroke
Association’s International Stroke Conference 2015.
This prospective randomized trial of tPA plus mechanical clot removal versus tPA alone combined the use of
the Solitaire FR retrieval device and "dual target" vessel occlusion and perfusion imaging selection. The
EXTEND-IA researchers investigated whether advanced imaging selection, superior devices and earlier
intervention would improve outcomes.
Seventy ischemic stroke patients were randomized to either tPA plus clot removal or tPA alone. The 35
patients in the IV-IA group had greater reperfusion at 24 hours and improved early neurological improvement
at 3 days and functional outcome at 3 months compared to the tPA only group.
The trial was stopped early in November 2014 when the release of positive MR-CLEAN trial results
prompted a review and the EXTEND IA data safety monitoring committee recommended stopping the trial for
overwhelming efficacy.
Bruce Campbell, MBBS, Ph.D., Consultant Neurologist and Head of Hyperacute Stroke, Department of
Neurology, Royal Melbourne Hospital, Parkville, Australia.
(INVITED PRESENTATION)
Solitaire™ FR as Primary Treatment for Acute Ischemic Stroke (SWIFT PRIME)
This prospective randomized trial sought to determine if patients experiencing an acute ischemic stroke due
to large vessel occlusion would have better outcomes if treated with a combination of intravenous clot busters
and mechanical clot removal with the Solitaire retriever device than if treated with intravenous clot busters
alone. The study was conducted at 39 hospitals in the United States and Europe. Patients were enrolled if they
could be treated with the mechanical clot removal device within 6 hours of symptom onset.
The primary outcome was the disability level at 90 days.
Researchers started enrolling study participants in Nov. 2012. Enrollment for the study was placed on hold
in November 2014, after recruitment of 196 patients, when the study monitoring committee noted compelling
differences between the treatment groups.
Jeffrey Saver, M.D., Professor of Neurology, Geffen School of Medicine, Director, UCLA
Comprehensive Stroke Center, Los Angeles.