The ESCAPE Trial aimed to assess the role for thrombectomy for patients with stroke due to anterior circulation proximal vessel occlusion. The study randomized 316 patients across 22 centers worldwide who presented within 12 hours with an acute stroke syndrome and anterior circulation occlusion on CT angiography to either standard therapy (IV alteplase within 4.5 hours) or standard therapy plus endovascular thrombectomy. The trial was stopped early due to efficacy.
Median time was 84 minutes in the trial. Interim analysis demonstrated endovascular therapy improved functional independence at 3 months (mRS 0-2: 58% versus 29.3%, p < 0.001). Stent retriever devices were used in 86.1% of cases with 100/130 patients receiving the Solitaire FR. Excellent angiographic revascularization (TICI 2b or 3) occurred in 72.4% of patients; IV alteplase administration did not improve revascularization in the stent retriever population. Groin access during IV alteplase infusion did not lead to increased femoral artery complications.
The study concludes that among patients with acute ischemic stroke with a proximal vessel occlusion, a small infarct core, and moderate-to-good collateral circulation, rapid endovascular treatment improved functional outcomes and reduced mortality.
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