ISC 16 ENDOVASCULAR TIP SHEET

February 17, 2016 Categories: Scientific Conferences & Meetings, Stroke News

All embargoed for 7 a.m. PT/10 a.m. ET, Wed. Feb. 17, 2016

In 2015, several clinical trials showed that removing stroke-causing blood clots in what is called “endovascular therapy” may be better than drug treatment and was a major breakthrough in stroke treatment. The research continues and now shows endovascular can save money, limit years disabled, preserve mental capacity, be given to a larger pool of patients and be more effective the sooner it’s done. According to an American Heart Association 2015 Focused Update, “Certain endovascular procedures have been demonstrated to provide clinical benefit in selected patients with acute ischemic stroke. Systems of care should be organized to facilitate the delivery of this care.”

Tip Headlines:

  • Quicker clot removal may lead to better outcomes
  • At less cost, stroke survivors may live longer and better if clots are removed
  • Clot removal plus clot-busting drug improved outcomes for larger group of stroke patients
  • Clot removal may save money and limit disability
  • Endovascular treatment may preserve mental capacity after stroke

Embargoed for 7 a.m. PT/10 a.m. ET – Abstract 2 (Room 408)

Quicker clot removal may lead to better outcomes

The faster a blood clot causing a stroke is removed, the less disability a patient may have, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

Previously, the SWIFT PRIME trial showed that patients with disabling ischemic (clot-caused) strokes were far less likely to die or be seriously impaired if their clots were physically removed with a clot retrieving device in addition to standard treatment with clot-busting drugs. In that trial, clot removal could be performed up to six hours after stroke onset.

In the current analysis of 83 patients who underwent clot removal, researchers examined whether patients did better if their clots were removed quicker. They found:

  • Overall, substantial blood flow was restored by clot removal in 88 percent of patients.

  • In those patients who had blood flow restored within 2.5 hours after stroke onset, 87 percent achieved functional independence (minimal or no disability).

  • Patients who had blood flow restored between 2.5 and 3.5 hours after stroke onset were 10 percent less likely to achieve functional independence than those who had earlier clot removal.

  • Every 60-minute delay after 3.5 hours resulted in a 15 percent lower likelihood of functional independence.

Researchers estimated that in a group of 100 stroke survivors, every six-minute delay in restoring blood flow would cost one survivor their functional independence, compared to those receiving early clot removal.

Ashutosh P. Jadhav, M.D., Ph.D., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Actual presentation date and time is 7:12 a.m. PT/10:12 a.m. ET, Wednesday, Feb. 17, 2016.

 

Embargoed for 7 a.m. PT/10 a.m. ET – Abstract 3 (Room 408)

At less cost, stroke survivors may live longer and better if clots are removed

At less cost, stroke survivors live longer and better if clot removal is added to clot-busting medication to treat ischemic strokes, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

Researchers examined recovery three months after 70 patients experienced a moderate to severe ischemic stroke, involving a clot blocking a large vessel. All had salvageable brain tissue on imaging and received the clot-busting drugs within 4.5 hours of stroke onset. In addition, half had their clots physically removed (thrombectomy). Researchers calculated disability level, quality of life scores, procedure and inpatient care costs. Among their findings:

  • Patients undergoing thrombectomy spent less time in the hospital (median 5 days vs 8 days).

  • Thrombectomy patients often needed no rehabilitation, while drug therapy patients spent a median of 27 days in rehabilitation.

  • Even after spending an extra $11,507 to transport patients and perform thrombectomy, inpatient care in the first three months following a stroke costed $2,417 less for patients who had their clots removed in addition to receiving tissue plasminogen activator (tPA).

  • Based on assessments three months after stroke, life expectancy was greater in the thrombectomy group (median 12.6 years) than in those receiving tPA alone (7.4 years).

  • Over a lifetime thrombectomy recipients were predicted to have more years with a higher quality of life (median 7.5) than those who received tPA alone (4.0 years).

  • Thrombectomy recipients were predicted to spend fewer years of their lives disabled (median 5.5) than those who received tPA alone (median 8.9).

Bruce Campbell, M.B.B.S., Royal Melbourne Hospital, Parkville, Australia.

Actual presentation date and time is 7:24 a.m. PT/10:24 a.m. ET, Wednesday, Feb. 17, 2016.

 

Embargoed for 7 a.m. PT/10 a.m. ET – Abstract 7 (Room 408)

Clot removal plus clot-busting drug improved outcomes for larger group of stroke patients

Physically removing a blood clot causing a stroke combined with clot-busting drugs improves the outcome of patients more than giving clot-busting drugs alone, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

Most trials investigating whether it is beneficial to add mechanical clot retrieval (thrombectomy) to the clot-busting drug tissue plasminogen activator (tPA) require that patients have evidence of salvageable brain tissue on imaging. In contrast, the French multicenter trial THRACE only used imaging to verify the presence of a clot in a large brain artery, so it enrolled a wider group of patients that included some with a poorer prognosis. Treatment was started within four hours of symptom onset. The trial was halted early after an intermediate analysis showed clear benefit for thrombectomy.

Among the final results:

  • After three months, 106 of 200 patients (53 percent) who received tPA plus thrombectomy were functionally independent, compared with 85 of 202 patients (42 percent) who received tPA alone.

  • Patients who received thrombectomy were no more likely to die or experience bleeding in the brain than those receiving tPA alone.

  • Nearly 30 percent of patients with poorest baseline prognosis achieved functional independence whatever the treatment group.

“The result is better in the thrombectomy group but the number of patients in each treatment group was too small to reach statistical significance,” said Serge Bracard, study author and head of the department of Diagnostic and Interventional Neuroradiology, University Hospital Nancy in France. “Combining intra-arterial treatment with IVT thrombolysis appears to be beneficial for all stroke patients regardless of age, sex, clinical severity or intracranial location of the occlusion.”

Serge Bracard, M.D., University Hospital Nancy, France.

Actual presentation date and time is 8:12 a.m. PT/11:12 a.m. ET, Wednesday, Feb. 17, 2016.

 

Embargoed for 7 a.m. PT/10 a.m. ET – Poster W MP12 (Hall H)

Clot removal may save money and limit disability

Adding mechanical clot removal to clot-busting drugs could lower stroke survivors medical bills, decrease government healthcare as well as non-healthcare related costs, and increase the likelihood of the patient returning to work and participating in society, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

Researchers analyzed combined data from six recent trials which compared the effect of acute stroke treatment when it consisted of endovascular therapy (mechanically removing clot) compared to  intravenous clot-busting drug (chemically dissolving drug) alone, in patients’ strokes that were caused by blockage of a large vessel supplying blood to the brain tissue. Reviewing outcomes and projected healthcare costs for 1,386 stroke survivors, researchers found:

  • Of the 688 who received IV tPA plus mechanical clot removal, 46 percent were independent after treatment with no or minimal disability.

  • Of the 698 who received the intravenous clot-busting drug tissue-plasminogen activator (IV tPA) alone, 27 percent were independent after treatment with no or minimal disability.

  • Estimated in-hospital and post-hospital healthcare costs for survivors achieving independence were $20,396, compared with $55,494 for those not achieving independence.

  • After adjusting for inflation, researchers estimate that if all patients in the trial had been treated with clot removal plus medication, versus all of them being treated with medication alone, 264 more patients would have become independent and $13,491,564 in healthcare costs would have been saved. That number does not include the cost imposed on families, the community and the future costs of disability.

  • If this number is extrapolated to the general population of stroke sufferers, simply implementing endovascular therapy at stroke centers could save billions of healthcare dollars each year.

Adding thrombectomy (mechanically removing clots) to chemical clot-busters translates to substantial cost benefits. Healthcare policies and guidance for physicians on thrombectomy should strongly consider clinical and financial benefits, researchers said.

Mohammad Moussavi, M.D. and colleagues, SNC at JFK Medical Center, Edison, New Jersey.

Actual presentation date and time is 6:10 p.m. PT/9:10 p.m. ET, Wednesday, Feb. 17, 2016.

 

Embargoed for 7 a.m. PT/10 a.m. ET – Poster W P27 (Hall H)

Endovascular treatment may preserve mental capacity after stroke

In addition to improving survival and reducing disability, mechanically removing the clot causing an ischemic stroke leads to better cognitive functioning, according to research presented at the American Stroke Association’s International Stroke Conference 2016.

Ninety days after an ischemic stroke in 206 people who previously had no cognitive problems, researchers administered two tests of executive functioning to the survivors.

On a test measuring visual attention and the speed of processing information, 61 survivors who had thrombectomy and 59 survivors given medication only were able to complete the test in a timely manner. Patients treated with thrombectomy completed the test more quickly although differences were not statistically significant.

However, on a more challenging measure of executive functioning (the ability to organize and prioritize thoughts and information), 39 in the thrombectomy group (64 percent of those that completed the first test) and 26 in the medication-only group (44 percent of those that completed the first test) were able to complete the test. Patients who received medical treatment alone needed significantly more time to complete the second test.

This indicates that executive functioning is better preserved and faster when patients undergo thrombectomy following an ischemic stroke, researchers said.

Elena López-Cancio, M.D., Ph.D.; Hospital Germans Trias i Pujol; Barcelona, Spain.

Actual presentation date and time is 6:15 p.m. PT/9:15 p.m. ET, Wednesday, Feb. 17, 2016.

 

Please also see the following LB abstracts -- NOTE:  they are embargoed until the times listed below.

  • Embargoed for 3:30 p.m. PT/6:30 p.m. ET, Wednesday, Feb. 17, 2016 (Room 408)

LB7 –Time is Brain in Endovascular Thrombectomy: Results From Individual Patient Pooled Data Analysis of Mr Clean, Escape, Extend IA, Swift Prime and Revascat

  • Embargoed for 1:30 p.m. PT/4:30 p.m. ET, Thursday, Feb. 18, 2016 (Room 408)

LB18 – Endovascular Treatment in Acute Ischemic Stroke: A Meta-analysis of Individual Patient Data From Mr Clean, Escape, Extend IA, Swift Prime and Revascat

Additional Resources:

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