Canadian researchers have completed an international randomized controlled trial showing that a clot retrieval procedure, known as endovascular treatment (ET), can dramatically improve patient outcomes after an acute ischemic stroke. The study, led by researchers at the University of Calgary's Hotchkiss Brain Institute (HBI), shows a dramatic improvement in outcomes and a reduction in deaths from stroke.
加拿大研究人员完成的一个国际性随机对照试验表明，凝块检索过程，即血管内治疗，简称ET，可以显著改善急性缺血性中风后患者的情况。这项研究由HBI的科研人员主导进行，它向我们展示了患者结果的显著转变以及中风死亡率的减少。
The results of this study were published in the Feb. 11 online edition of the New England Journal of Medicine (NEJM).
这项研究成果发表在2月11日网页版的 《新英格兰医学杂志》上 ( NEJM )。
Overall, positive outcomes for patients increased from 30 per cent to 55 per cent. In many cases, instead of suffering major neurological disability, patients went home to resume their lives. The overall mortality rate was reduced from two in 10 patients for standard treatment of care to one in 10 patients -- a 50 per cent reduction with ET.
总体来说，接受ET治疗后产生积极结果的患者从30%上升到55%。在许多病例中，患者可以回家重新开始他们的生活，而不是继续饱受神经系统残疾之苦。 总体死亡率也从治疗护理的标准死亡率20%下降到了10%。也就是说，通过血管内治疗减少了50%的死亡率。
"This is the most significant and fundamental change in acute ischemic stroke treatment in the last 20 years. These results will impact stroke care around the world," says Dr. Michael Hill, the senior author of the study, professor in the Cumming School of Medicine's departments of clinical neurosciences, and radiology and a neurologist with the Calgary Stroke Program of Alberta Health Services (AHS).
“综观过去20年治疗急性缺血性中风的历程，这无疑是一个根本性的重大改变。这些结果将影响到世界各地的中风治疗，”这项研究的资深作者，Cumming学院医学部临床神经科的教授AHS的Calgary中风计划的放射学和神经学家迈克尔•希尔博士说。
The clinical trial, known as ESCAPE (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times), shows there is a marked reduction in both disability and death among patients who receive ET for acute ischemic stroke. Ischemic stroke is caused by a sudden blockage of an artery to the brain that deprives the brain of critical nutrients, such as glucose and oxygen. Currently, the international standard of care based on Canadian, U.S. and European guidelines is to administer a drug called tPA when appropriate. Known as a 'clot buster', the drug dissolves the blood clot.
一个名为ESCAPE的临床试验显示，接受ET治疗的缺血性中风患者残疾和死亡人数显著减少。 缺血性中风是由于大脑动脉突发性阻塞而导致大脑的关键营养物的丧失，如葡萄糖和氧气等。 目前， 依据加拿大，美国和欧洲的方针制定的护理国际标准，是在合适的时候给病人施用一种名为tPA的药物。这种药物可以溶解血液凝块，被称为“凝块克星”。
In the ESCAPE trial, 316 patients who fit the criteria for ET and arrived for treatment within 12 hours of their stroke were randomized to standard medical care (which included the clot-busting drug tPA where appropriate) or standard medical care plus ET.
在ESCAPE试验中，符合ET治疗标准并能在12小时内接受中风治疗的316名患者，被随机分配到标准治疗组(包括适时服用溶栓药物tPA)和标准治疗联合ET治疗组。
ET is performed by inserting a thin tube into the artery in the groin, through the body, and into the brain vessels to the clot. This is done under image-guided care using an X-ray. The clot is then removed by a retrievable stent and pulled out, restoring blood flow to the brain.
血管内治疗是在动脉腹股沟里插入一根细管，贯穿身体，直至大脑血管中的凝块。整个过程在图像引导下使用x射线完成。然后凝块通过一个可收回支架去除并拉出，使血液重新流向大脑。
Endovascular treatments were first developed in the 1990s, but ET has only recently been technically possible. The ESCAPE team says the success of the trial can be credited to very fast treatment and the use of brain and blood vessel imaging. In ESCAPE, researchers were on average two hours faster in opening the blocked blood vessels than in previously reported trials.
血管内治疗方法在1990年代首次被开发，但最近才在技术上实现可能。EASCAPE团队认为实验的成功可以归功于快速治疗和大脑及血管成像的使用。 在EASCAPE实验中，研究人员打开阻塞血管的速度比之前报道的实验平均快了两小时。
"Key reasons for the success of the trial were, firstly, selecting appropriate patients using novel imaging technology; secondly, better organization and workflow to expedite treatment; and thirdly, use of modern technology to open the blood vessels," says Dr. Mayank Goyal, professor of radiology and clinical neurosciences at the Cumming School of Medicine, co-principal investigator of the ESCAPE trial and first author on the publication, and lead interventional neuroradiologist on the ESCAPE trial. He performs the procedure at Foothills Medical Centre in Calgary, Alberta. "We believe that with the combined results from this trial and other trials, this will become the standard of care."
Cumming医学院放射学和临床神经学教授，ESCAPE实验的副首席科学家以及第一个正式出版的作者，介入性神经系放射学家，博士Mayank Goyal说：”试验成功的关键因素有三，首先，选择合适的患者使用新型成像技术；其次，更好的组织和工作流来加快治疗；第三，使用现代科技打开血管，”他在阿尔伯塔省卡城的山麓医学中心演示了实验的过程并表示： “我们相信，通过这次试验结果同其他试验结果的结合，这种疗法将成为标准治疗。”
ESCAPE is the second ET trial that demonstrates the efficacy of the treatment and the first trial to demonstrate reduced mortality. The previous trial, known as MR. CLEAN (Multi center Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands), was published in December 2014.
ESCAPE是第二个血管内治疗试验，它证明了这种疗法的有效性，并且第一个证明了该疗法能够降低死亡率。之前的实验，被称为清洁先生(在荷兰治疗急性缺血性中风的血管内治疗的多中心随机临床试验)，于 2014年12月发表。
"This breakthrough has the potential to improve the lives of the 15 million people who suffer strokes worldwide each year," says Ed McCauley, PhD, vice-president (research), University of Calgary. "University of Calgary researchers have been transforming health outcomes for close to 50 years now, and the work of Drs. Michael Hill, Mayank Goyal, and Andrew Demchuk will improve the quality of life for Albertans, Canadians and people around the world."
“这项突破将有助于改善全世界每年1500万中风患者的生活”埃德•麦考利说， 卡尔加里大学的博士及副校长（研究)。 “卡尔加里大学的研究人员致力于转变中风患者的治疗结果研究将近50年之久，同Drs. Michael Hill， Mayank Goyal， and Andrew Demchuk一起工作也将改善艾伯塔，加拿大，乃至世界各地的人们的生活质量。”
"This remarkable achievement by the HBI Stroke Team is a shining example of brain research at its very best," says Samuel Weiss, PhD, HBI Director and leader of the University of Calgary's Brain and Mental Health strategy. "Our vision of 'Healthy Brains for Better Lives' has taken a giant leap forward."
“HBI中风研究团队的这项非凡成就无疑是大脑研究中最耀眼的一个例子，”塞缪尔•维斯说， HBI主席，卡尔加里大学大脑和心理健康策略组织的领导。 “我们对 ‘健康的大脑，更好的生活’的憧憬又向前迈出了跳跃性的一大步。”
While research is improving outcomes, doctors still want patients to know the warning signs and symptoms of stroke.
虽然相关研究正在不断改善中风后的结果，但医生们仍希望病人可以了解中风的征兆和症状。
"Many stroke treatments work only if administered in a set period of time. Many patients don't get to the hospital in time. With stroke, when removing the clot with this new treatment, every minute matters," says Dr. Andrew Demchuk, another ESCAPE co-principal investigator and leader of both the Stroke Program at Foothills Medical Centre and the HBI Stroke Team. "If patients have facial drooping, arm weakness or speech difficulty, they need to call 9-1-1 immediately."
“许多中风治疗只有在规定的时间内管理才会奏效， 但许多患者无法及时赶到医院。对中风患者而言，用新疗法去除血凝块的的时候，每一分钟都很重要，” Andrew Demchuk博士说，另一位ESCAPE的副首席科学家，HBI中风团队和山麓医疗中心中风计划的领导人。 “如果患者面部下垂，手臂无力或讲话困难，那么他们需要立即呼叫9-1-1。”
The study included 22 sites worldwide and patients in the U.S., U.K., Ireland and South Korea. Canada had 11 participating hospitals and enrolled two-thirds of the patients.
这项研究包括全球22个站点，以及来自美国、英国 、爱尔兰和韩国的患者。 加拿大有11所参与研究的医院，并已登记注册了三分之二的病人。
In addition to being published online, the results of this landmark study will be published in the March 19 print edition of NEJM and presented at the American Heart Association's International Stroke Conference in Nashville, Tenn.
除了在网上公布，这一具有里程碑意义的研究成果将还发表在3月19日 NEJM 的印刷版上，并在田纳西州的纳什维尔，美国心脏协会举办的国际中风会议上进行演说展示。