A recent study has shown that endovascular thrombectomy, a minimally invasive procedure that removes blood clots, can improve the outcomes of patients with large ischaemic strokes.

The study, published in the prestigious New England Journal of Medicine (NEJM), was carried out across 31 centres in North America, Europe, Australia, and New Zealand and was terminated early due to positive results.

Joint senior author, director of the RMH Neurology service, Professor Bruce Campbell said the study compared using endovascular thrombectomy to standard medical care for patients who had a stroke caused by a blocked blood vessel in their brain.

“A trial led by the RMH in 2015, showed that physically removing the clot with a minimally invasive procedure called thrombectomy improved patient outcomes after stroke caused by a large blocked blood vessel," said Prof Campbell.

"However, patients with large areas of injury when they arrived in hospital were excluded from that trial and other trials internationally,” he added.

This new study has clearly shown that many of those patients still benefit. These patients have severe stroke – not all are able to return to independence or walking unassisted, but the reduction in the need for nursing home care and death is substantial.

“This means reduced disability for a substantial number of patients who were previously not considered treatable,” Prof Campbell said.

The results of the study showed that 20 per cent of patients (one in five) who underwent thrombectomy returned to independent function, compared to only 7 per cent of patients who received medical care alone.

Getting back to walking independently is another important outcome for patients and was twice as likely to occur with thrombectomy (in 38% of patients) compared to 19% with medical care.

The trial was terminated early for efficacy after 352 patients had been enrolled in the study.

This ground-breaking study is a significant step forward in the treatment of large ischaemic strokes.

“We have seen improved outcomes and functional independence in patients who underwent thrombectomy which does offer hope to others who may experience a stroke in the future,” Prof Campbell said.

The RMH Patient *Jack presented after having a major stroke – the extent of injury on his brain scan would have usually have excluded him from thrombectomy treatment.

He was treated with thrombectomy as part of the trial and had an excellent outcome. Instead of the expected severe weakness, immobility and cognitive effects from such a large stroke, he was able to walk again after only a few days and managed to get back home after just 3 weeks in rehabilitation.

“I’m so grateful for the care I received, and I feel very lucky to have been part of the trial,” Jack said.

*Name changed for privacy

Mobile Stroke Unit with Ambulance Victoria paramedic and the RMH Stroke team
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