EuroPCR Lecture Encourages Adoption of New Generation of Mechanical Thrombectomy Devices for Stroke Treatment

May 20, 2015—Experts speaking at the EuroPCR 2015 conference stated that the numerous positive results for stent retrievers, the new-generation endovascular devices for the treatment of acute stroke, warrant a call to action to ensure swifter implementation of this technology. Stent retrievers are mechanical thrombectomy devices that use catheters introduced into a blocked cerebral artery to remove by suction or to lyse a clot that is cutting off circulation to part of the brain.

A special breaking news session at EuroPCR was devoted to this rapidly evolving field to review the recent evidence and discuss the rationale for boosting use of the therapy. EuroPCR 2015 is being held May 19–22 in Paris, France.

As summarized in a EuroPCR press release, seven clinical trials in the past 6 months have demonstrated that intracranial thrombus retrieval or lysis is feasible and safe and yields significant improvements in neurological functional on top of best medical therapy (including intravenous thrombolysis, when indicated), as compared to best medical therapy alone. The seven trials include REVASCAT, THRACE, MR CLEAN, ESCAPE, EXTEND-1A, SWIFT PRIME, and THERAPY.

“Acute ischemic stroke is as common as acute coronary syndrome, but the prognosis is still very grave,” commented Petr Widimsky, MD, in the EuroPCR press release. Dr. Widimsky is Head of the Cardiocenter and Chair of the Cardiology Department at the Third Faculty of Medicine, Charles University & University Hospital “Royal Vineyards” in Prague, Czech Republic. 

With conservative treatment following a moderate or severe stroke, only 10% of patients will recover to the state of functional independence, noted Dr. Widimsky. He added, “So, 90% of patients who are not treated die or are severely disabled. Thrombolysis increases the rate of people who return to functional independence from 10% to 20%–25%, but that still leaves 75% disabled or dead.”

According to Dr. Widimsky, the accumulated evidence from the various clot retrieval trials published or presented in the past few months suggests that the number of moderate/severe stroke patients who regain full or near-full neurological function rises to 40% to 50% with this novel therapy. He stated, “And with good patient selection, that may increase to 60%. Sometimes we face something that looks close to a miracle when we are treating a patient with a severe stroke, who is profoundly disabled, and he makes a full recovery before your eyes. It's really dramatic.”

Dr. Widimsky noted that a range of clot retrieval systems already hold regulatory approval in both Europe and North America, but implementation into practice will require the concentrated effort of many parties. He commented, “It is a difficult technique routinely used so far only in a few comprehensive stroke centers and physicians need the appropriate training, but these data have only been out for a few months. If you remember the story of myocardial infarction, the fact that myocardial infarction should be treated with coronary angioplasty was known in 1993, but it took 10 years before it was widely used.”

There are risks to the procedure, acknowledged Dr. Widimsky, with an adverse event rate in the range of 5%. The most important risks are intracranial bleeding or new stroke in another territory caused by a clot fragment embolizing during removal. So far, most of the procedures in Europe are being performed by radiologists, and in the United States, they are being performed primarily by neurosurgeons, but Dr. Widimsky predicts there will be wider uptake in the coming years by angiologists, neurologists, vascular surgeons, and cardiologists, depending on the local situation.

“We are highlighting these new data here at EuroPCR in order to spread the message that this therapy shows great promise. We need to build health care systems and train physicians to be able to offer this effective method to as many patients with acute ischemic stroke as possible,” concluded Dr. Widimsky in the EuroPCR announcement.