Trying Escape Mevo advances understanding of stroke treatment for medium-sized vascular blockages

Trying Escape Mevo advances understanding of stroke treatment for medium-sized vascular blockages

Researchers from the University of Calgary's Hotchkiss Brain Institute with the Calgary Stroke Program at Foothills Medical Center revolutionized treatment for stroke with the Escape Trial, proving that a coagulation procedure called endovascular thrombectoma (EVT) can be performed after a patient with an acute ischemic stroke caused by a blockage caused by a blockage in a large blood vise.

Building on this knowledge, the team launched the Escape-Mevo clinical trial to evaluate whether ischemic stroke patients with blockages in smaller medium-sized vessels could also benefit from EVT. Ischemic strokes are the most common form of stroke. The study, published in theNew England Journal of Medicine,found that EVT does not lead to improved outcomes.

When someone has a stroke, it's important that doctors know what the best approach is for each situation. Brain cells die quickly when blood flow stops. The brain is fed by a network of arteries of varying sizes. Our results show that patients with blockages in medium-sized vessels in the brain who had endovascular treatment did not fare better and did not see any improvement compared to patients with the standard of care. “

Dr. Mayank Goyal, MD, PhD, interventional neuroradiologist, clinical professor at Cumming School of Medicine (CSM) and study co-principal investigator

The international study included 530 patients at 58 sites in five countries. Patients were randomly assigned into two groups; One group received usual care, the second received EVT plus usual care. Patients were evaluated 90 days after stroke. Results were measured using the modified Rankin score, a clinical tool that measures the level of disability a person experiences after a stroke, and the Barthel Index score, which measures a patient's ability to complete daily tasks.

“Our results will help doctors better determine the best treatment for their patient,” says Dr. Michael Hill, neurologist, professor at CSM and study co-principal investigator. “Knowing standard medical care, often involving thrombolytic (“clot bust”), is best for resource blockages in medium-sized vessels and ensuring each patient receives the appropriate care for their situation.”

Hill said the results are particularly important for doctors who see stroke patients in smaller centers and rural locations where availability may not be available. The study will continue to follow patients for one year. Convince whether delayed benefit emerges with a longer evaluation period.

“Ultimately, we do this research because we want to improve treatments for patients and reduce death and disability from stroke,” says Goyal. "This study helps us better understand when EVT is effective and when it is not. This knowledge is important."

Goyal and Hill will present the results at the International Stroke Conference in Los Angeles, California on February 5, 2024.

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