To help educate our Primary Care Providers and Health Care Providers across the Northeast, we have pulled together a list of education sessions that have been presented in the last six months on Endovascular Therapy (EVT) in Ontario.
On February 11, 2015 the Canadian Stroke Best Practice Recommendations were updated to include EVT as a standard of care for clinical management of hyper-acute ischemic strokes.
Prior to this, the standard of care for acute ischemic stroke was intravenous (IV) tissue Plasminogen Activator (tPA) thrombolysis. However, the benefit of IV tPA is significantly less in large artery occlusions and some patient are unable to receive IV tPA due to contra-indications such as bleeding risk or recent surgery.
EVT is an image guided mechanical clot removal (embolectomy), using a catheter inserted through the groin. It is performed by specialists with neurointerventional expertise.
Five randomized controlled trials have all demonstrated remarkable efficacy and safety of this new treatment with consistently better patient outcomes. The MR CLEAN Trial was completed and demonstrated positive outcomes. Subsequently, the ESCAPE trial was stopped early due to overwhelming positive results and concurrent positive results of the EXTEND-IA3 trial. Two further trials SWIFT PRIME4, and REVASCAT5 were stopped early and results have been published. Below is a pictorial of the results of the Escape Trial demonstrating reduction of patient disability and mortality compared with the current standard of tPA alone.
M. Hill (ESCAPE) 2015
EVT is for patients with large artery occlusions (moderate – severe) who may or may not have received IV thrombolysis. Patient selection is based on the presence of a large proximal artery occlusion with good collaterals as confirmed with CTA imaging. Estimates are that this equates to about 10% of the ischemic stroke population. As with tPA, time and speed are critical to optimize the benefits of EVT. While the treatment window from stroke onset is 6 hours, the time from CTA to initiation of endovascular intervention has been identified as a key parameter for success
The Ontario Stroke Network formed a Provincial EVT Working Group and they have developed an imaging protocol, transfer protocols and have been the providers of much of the education to date. They continue to work to help develop the system to expand access to EVT for as many appropriate patients as possible.
Download the summary of EVT education here.