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Ground-breaking study: New stroke treatment reduces death by 50 per cent

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​​​Image of Dr. Timo Krings
Macy Mills was on her way to pick up her three boys from school when she felt her body go numb and lost control of her car. She was suffering from a stroke. (Photo: Macy Mills)​

Panicking and unable to move her left side, all Macy Mills could do was honk her car horn to call for help.

Earlier in the day, Macy had been working out when she felt the onset of a headache. A serious athlete – she had a couple of marathons and a half-ironman title to her name – she had been doing some interval training while running on a track. The headache persisted and was enough to sideline the rest of her workout.

Later that day, while on her way to pick up one of her three boys from school, she felt the left side of her body go numb as she tried to park her car. She lost control of the steering wheel, nicked the car parked next to her, and sensed she couldn't move or talk. She started honking the horn to get someone's attention.

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Rushed to Toronto Western Hospital (TWH), the now 42-year-old vice president at a bank in Toronto had suffered an ischemic stroke caused by a blockage in the arteries in her brain. But as luck would have it, TWH had been trying a new approach to treat such a blockage with a surgical procedure.

The clot retrieval procedure, known as endovascular treatment (ET), had been shown to improve patient outcomes after suffering an ischemic stroke. Early results were so promising that TWH eventually enrolled in a multi-centre trial with 21 other hospitals in Canada and around the world to see how this procedure compared to the standard treatment for ischemic stroke.

The standard treatment for a stroke of this kind is to give the patient tPA, a drug that is delivered through an IV and helps break down the blood clot lodged in a brain artery that has cut off the flow of blood and oxygen. However, there are limitations to tPA, mainly that tPA needs to be administered no later than 4.5 hours after a patient suffers a stroke in order for it to be effective. This treatment method has only about a 30 per cent success of reversing any damage to the brain caused by the stroke.

The ET procedure had already been around since the 1990s as a method to remove blood clots from other parts of the body. With the advancement of technology, the more efficient stent retriever was developed a few years ago. The new stent was such a game changer that researchers began to hypothesize whether the ET procedure could be used to remove blood clots in the brain arteries that were too big to be dissolved by tPA.

ET is performed by inserting a thin tube into the artery in the groin, through the body, and into the brain arteries to the clot. This is done under image-guided care using an X-ray. The clot is then removed by a retrievable stent and pulled out, restoring blood flow to the part of the brain that was being damaged.

A clinical trial, known as ESCAPE (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times) was formed to test the effectiveness of the ET procedure to treat blood clots causing strokes.

Led by researchers at the University of Calgary's Hotchkiss Brain Institute (HBI), the study showed such dramatic improvement in outcomes and a reduction in deaths from stroke that the trial was stopped early due to its efficiency. The results were published in the Feb. 11 online edition of the New England Journal of Medicine (NEJM).

Image of Macy Mills and her three boys  
Dr. Timo Krings, Interventional Neuroradiologist, Joint Department of Medical Imaging (JDMI), does a demonstration of the endovascular treatment with a stent retriever. The procedure is being used as a new approach to treat blood clots caused by stroke. (Photo: UHN).​


The Toronto Western Hospital was a major contributor to the data used for the analysis with Dr. Timo Krings, interventional neuroradiologist, Joint Department of Medical Imaging (JDMI) and Dr. Frank Silver, neurologist also named as co-authors.

Overall, excellent recovery from patients who suffered a stroke increased from 30 per cent to 55 per cent. In many cases, instead of suffering major neurological disability such as paralysis and impaired speech, patients went home to resume their lives. The overall death rate was reduced from two in 10 patients for standard treatment of care to one in 10 patients – a 50 per cent reduction with ET.

"This is the greatest advancement in the treatment of acute ischemic stroke that we have seen in almost 20 years," says Dr. Leanne Casaubon, Neurologist and Director of the Transient Ischemic Attack and Minor Stroke (TAMS) Unit at the Krembil Neuroscience Centre, Toronto Western Hospital. "These results are very exciting for the potential they have to impact stroke care around the world."

Furthermore, for patients who are not candidates for tPA due to medical history or getting to the hospital after the 4.5 hour cut off, there is now an option available that can potentially help them avoid permanent neurological damage from stroke.

Image of Macy Mills training for her next race 
Macy Mills is back on her feet and has resumed training for her next race,
an Olympic distance triathlon. (Photo: Macy Mills)​

For Macy, the results were dramatic.

Treated with a combination of tPA and an ET procedure performed by Dr. Richard Farb a neuroradiologist from JDMI, she was in the hospital for a week but was then placed on blood thinners and sent home. Although she still feels some weakness as a result of the stroke, she has resumed training and is looking toward to her next race, an Olympic distance triathlon.

"Words are insufficient to express my appreciation for the team at Toronto Western Hospital who saved my life," she said. "I know my three boys, my husband, and my parents are also forever grateful and I am just so thankful for the amazing outcome after having this procedure."​


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