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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EESCAPE was a phase 3, multicenter, prospective, randomized, open-label, controlled trial conducted in patients with acute ischemic stroke. Patients received rapid, modern endovascular treatment plus guideline-based care (intervention) or guideline-based care alone. Patients in the intervention group had greater benefits in mortality, morbidity, and quality of life compared with controls.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EESCAPE\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethrombectomy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ealteplase\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eischemic stroke\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecomputed tomography\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emultiphase computed tomography angiography\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EMichael D. Hill, MD, and Mayank Goyal, MD, University of Calgary, Calgary, Alberta, Canada, jointly presented the results of the ESCAPE trial [Goyal M et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015], a phase 3, multicenter, prospective, randomized, open-label, controlled trial with a blinded outcome evaluation. The study was conducted at 22 centers in Canada, the United States, South Korea, the United Kingdom, and Ireland. Patients were randomized in a 1:1 ratio to modern endovascular treatment plus guideline-based care (intervention group) or guideline-based care alone (control).\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EEligible patients had to have acute ischemic stroke (National Institutes of Health Stroke Scale [NIHSS]\u2009\u0026gt;\u20095) within a 12-hour window and good premorbid functional status. There was no upper age limit for participants in the study. Results from the patient\u2019s imaging were required to show a small core, proximal intracranial artery occlusion, and moderate-to-good collateral circulation using computed tomography (CT) or multiphase CT angiography. The use of magnetic resonance imaging was discouraged.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe study focused on rapid endovascular treatment, with a target time of 60 minutes from head CT (first slice) to groin puncture and 90 minutes from head CT to the first reperfusion, to enable fast imaging and interpretation. Intravenous tissue plasminogen activator (tPA) was administered to appropriate patients according to standard of care. The investigators were encouraged to use retrievable stents and balloon guide catheters and to avoid general anesthesia. The primary outcome was the modified Rankin scale (mRS) score 90 days post-randomization. Safety end points were also measured.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe ESCAPE trial steering committee stopped recruitment in October 2014 after the presentation of the MR CLEAN trial results [Berkhemer OA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015]. A planned interim analysis was completed early, and ESCAPE was discontinued by the Data Safety Monitoring Board in November 2014 because the prespecified efficacy boundary had been crossed.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EA total of 316 patients were enrolled, 165 in the intervention group and 150 in the control group; 1 patient was excluded due to informed consent issues. Baseline characteristics were similar in the 2 groups: median age close to 71 years, \u0026gt;\u200950% women, median NIHSS scores around 16, and approximately one quarter with occlusion of the internal carotid artery. In the intervention group, the median time from CT to groin puncture was 51 minutes, from CT to first reperfusion was 84 minutes, and from stroke onset to first reperfusion was 241 minutes. Around 75% of each group received intravenous tPA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EEfficacy and safety end points are presented in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E. Benefits in mortality, morbidity, and quality of life were observed when the intervention arm was compared with the control arm.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15273\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15273\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15273\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EESCAPE Efficacy and Safety Outcomes\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EAdditional subgroup analyses favored intervention across all groups including patients over the age of 80 years. The investigators concluded that endovascular thrombectomy is a safe intervention, reducing mortality and disability when patients are carefully selected using imaging, when treatment is administered very quickly, and when safe, effective technology, such as retrievable stents, is employed.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/2\/9.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlqk4\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlqk4\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}