ESMINT News

Three positive thrombectomy trials presented at International Stroke Conference 2015 (Nashville, TN)
12 February, 2015 - 20:38

February 11, 2015 will be an important milestone in the history of Interventional Neuroradiology. Three positive trials (ESCAPE, EXTEND-IA, and SWIFT-PRIME) evaluating mechanical thrombectomy in acute ischemic stroke were presented under the applause of a large audience. Both ESCAPE and EXTEND-IA trials were published online in NEJM the day of ISC presentation (February 11, 2014).

The positive results of MR CLEAN presented at the World Stroke Conference in Istanbul in October 2014 was prompting the performance of interim analyses in several running RCTs evaluating mechanical thrombectomy (ESCAPE, EXTEND-IA, SWIFT-PRIME) that were all positive.

The ESCAPE (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times) trial (presented by Michael D Hill, Calgary, Canada) was interrupted after randomization of 315 patients. Inclusion criteria were NIHSS > 5, occlusion of the middle cerebral artery trunk and its immediate branches with or without ICA occlusion, small infarct core (ASPECT 6 to 10), moderate to good collaterals on CTA. Enrollment was possible up to 12 hours. The patients received rtPA if they were eligible for this treatment.

A total of 316 patients underwent randomization before the trial was stopped: 165 in the thrombectomy group and 150 in the control group (1 patient was excluded). About 75% of patients received IV rt-PA and  stent-retrievers were used in 86.1% of patients in the thrombectomy group. The adjusted risk ratio for a mRS shift with thrombectomy at 90 days was 3.1. A mRS of 0-2 at 90 days was observed in 53.0% in thrombectomy vs. 29.3% in controls (p<0.001). Mortality was significantly lower in intervention group (10.4%) compared to 19.0% in control group. All subgroups of patients had similar benefit, including the elderly.

The EXTEND-IA (EXtending the time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial therapy) trial (presented by Stephen M Davis, Parkville, Australia) was prematurely stopped because of a positive interim analysis of the first 70 randomized patients (35 in the intervention group and 35 in the control group). Patients were eligible if they could receive rt-PA within 4.5 hours after the onset of anterior circulation ischemic stroke and had occlusion of the internal carotid artery or of the first or second segment of the middle cerebral artery on CTA or MRA, to have received IV thrombolysis < 4.5 hours. CT perfusion imaging (use of the fully automated software RAPID) was used to identify potentially salvageable brain tissue. Endovascular therapy had to be initiated (groin puncture) within 6 hours after stroke onset and completed within 8 hours after onset.

A total of 70 patients were included in the trial (35 in intervention arm and 35 in IV rt-PA arm). All patients in the intervention group were treated with Solitaire. Early reperfusion of the ischemic tissue at 24h hours was 100% in intervention group vs. 37% in the control group (p<0.001). Early neurologic improvement  (NIHSS reduction ≥ 8 points or NIHSS 0-1 at 3 days) was 80% in intervention group vs 37% in the control group (p<0.001). mRS 0-2 at 90 days was 71% in thrombectomy patients and 40% in controls (p<0.01). There was a trend towards reduction of mortality (9% in intervention group; 20% in control group; p=0.18).

The SWIFT PRIME (Solitaire™ With the Intention For Thrombectomy as PRIMary treatment for acute ischemic strokE) trial (presented by Jeffrey L Saver) was prematurely stopped after a positive interim analysis of the first 196 patients. To be included, patients have to receive IV thrombolysis 4.5 hours after stroke onset, a NIHSS between 8 and 29, CTA or MRA confirmation of large vessel occlusion (intracranial internal carotid artery or M1 segment of the MCA), and an ASPECTS > 6.

As ESCAPE and EXTEND-IA, SWIFT-PRIME was prematurely halted due to positive interim analysis. A total of 196 patients were randomized, 98 in each group (intervention and IV rt-PA). In Intervention group, TICI 2b/3 was obtained in 88.0% of patients. The OR for a mRS shift at 90 days with thrombectomy using the Solitaire™ FR stent retriever was highly significant (p= 0.0002). Good functional outcome (mRS 0-2 at 90 days) was obtained in 60.2% in intervention group and 35.5% in IV rt-PA group (p < 0.001). Death at 90 days was 9.2% in intervention group and 12.4% in rt-PA group (p=0.5).
 
In summary, following the positive results of MR CLEAN, a further 3 positive trials have validated the use of mechanical thrombectomy for patients with acute ischemic stroke with large vessel occlusion in the anterior circulation. Indeed, these results will have a tremendous impact on the management of these patients and also on the organization of stroke care.

All investigators and sponsors of these trials should be congratulated for their tremendous work!

Laurent Pierot – Reims - France

References:

  1. Goyal, M., et al., Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N Engl J Med, 2015. [NEJM] [PDF]
  2. Campbell, B.C., et al., Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection. N Engl J Med, 2015. [NEJM] [PDF]
Season’s Greetings from ESMINT
24 December, 2014 - 11:20

Dear Colleagues, Friends, dear Members of the Society,

The ESMINT would like to take this opportunity to wish all members, families, friends and all collaborative partners Seasonal Greetings and best wishes for the New Year.

Five years have passed since the inauguration of our Society. Due to the meaningful work of all of you we grew from 100 to more than 500 members, we established a highly successful Annual Congress in Nice and managed to establish a strong and still growing cooperation with the neurosurgical and neurological communities in Europe. Our website is active and providing a worldwide unique service: the Device Directory.

The most significant recent milestone is the launch of ESMINT’s curriculum based, structured training in neurointerventional therapy. The first ECMINT course was held in Oxford this December, organized by the ESMINT Educational Committee (chaired by Dr. Shelley Renowden) and directed by Prof. James Byrne.

On behalf of the Executive Board, I would like to thank you very much for your support throughout 2014 and we look forward to an exciting and successful 2015.

Sincerely yours,

Istvan Szikora
President

Results of the 'MrCLEAN' clinical trial published by the NEJM
17 December, 2014 - 19:44

Today, December 17th 2014, the New England Journal of Medicine published the results of the MrCLEAN trial (Multicentre Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands). This prospective randomised trial was designed to show the potential of intra arterial (endovascular) treatment of ischemic stroke in comparison to conventional treatment with intravenous thrombolysis. The results of this trial are strongly positive towards intra arterial therapy, and will have a major impact on the future treatment of ischemic stroke.

The ESMINT (European Society of Minimally Invasive Neurological Therapies) strives towards a scientifically funded use of endovascular techniques in neurovascular pathology, by suitably trained and skilled medical specialists. In this respect the ESMINT applauds the researchers for their work and welcomes the outcome of the trial wholeheartedly.

Having said this, the ESMINT also warrants restraint since these complex endovascular procedures are highly operator dependent and should not be executed by persons without appropriate training and neurovascular knowledge. Execution of these procedures by anyone other than endovascularly trained neurovascular specialists poses a risk, both for the patients and the future of this technique. Awareness of these risks is of the utmost important to both legislators and hospital administrations that may consider employing doctors lacking the necessary training. Centralization of this particular service needs to be considered and may well be the only way to achieve the trial results in routine practice.

For more information please contact ESMINT directly.

The article can be read online here:
http://www.nejm.org/doi/full/10.1056/NEJMoa1411587#t=article

MrCLEAN
11 November, 2014 - 00:07

On October 24th the results of the MrCLEAN trial were presented orally at the World Stroke Congress in Istanbul.

The ESMINT board recognizes that the outcome of the trial has many implications for our field and as soon as the peer-reviewed MrCLEAN data is published a formal statement and press release will be released.

December ECMINT Training Course is full.
11 November, 2014 - 00:04

We can now announce that the December ECMINT training course in Oxford is now full. We will shortly be announcing some new dates for 2015. If you have completed the registration form but were not allocated a place in December your application will be prioritised when the new dates are announced.

Dear Colleagues, dear Friends,

This is to let you know, that registration for the ECMINT 1 course to be held in Oxford, December 15- 19 has been very successful. All available places were booked by the end of October, so the organizers have closed registration.

We consider this as a success. The strong interest in the course confirms that ESMINT has moved in the right direction in its educational strategy. It is our intention to keep moving in this direction and increase our capacity in the near future. We would like to reassure those who did not have a chance to get attend this first course that they can start their cycle in June, 2015 at ESMINT 2.

Keep an eye at the Website, registration will start again early next year!

On behalf of the Board of ESMINT we all look forward seeing you in Oxford.

Istvan szikora

Congress 2014 Presentations now available
24 September, 2014 - 23:54

Selected presentations from the 6th ESMINT Congress 2014 are now available for members.

> 2014 Congress Presentations (members only)

Building the future of ESMINT
23 September, 2014 - 23:33

Dear Colleagues, Friends, dear Members of the Society,

Five years have passed since the inauguration of our Society. During this period, we grew from 100 to over 500 members, and have just completed a hugely successful Annual Congress, with 631 registered participants. According to our mission, we managed to establish a strong and still growing cooperation with the neurosurgical and neurological communities in Europe. Our Website is active and providing a worldwide unique service in the form of the Device Directory. With all of these achievements, ESMINT is now likely the most influential organization of neurointerventionists in Europe.

The most significant recent milestone is the launch of ESMINT’s curriculum based, structured training in neurointerventional therapy. The first ECMINT course will be held in Oxford this coming December, organized by the ESMINT Educational Committee (Chaired by Dr. Shelley Renowden) and directed by Prof. James Byrne. It will be the only training activity organized by ESMINT. Unique in Europe, our Society will be able to teach all of the basic knowledge needed for neurointerventions and we plan to provide a UEMS approved European diploma to attendees who successfully complete the assessments which form part of the 4 courses in this 2 years cycle. The organizers of the previous ESMINT teaching courses will continue an advanced course, ANIC in Barcelona.

The primary aim of the newly elected Executive Committee (ExCom) is to continue to strengthening the impact of our Society on the practice of minimally invasive neurological therapy in Europe. This is of outmost importance these years with interventional treatment of ischemic stroke quickly becoming a routine practice. Not surprisingly, the new technology is spreading more quickly as the numbers of trained personnel grows. It is our responsibility now to preserve the leadership of highly trained neurointerventionists in this field. The only way to do that is to take the lead in training and the commissioning of clear guidelines, both of which is now on the way. The ExCom will continue its work in the other territories that we were involved in the past. I would like to strongly encourage all of you to contribute to the ExCom’s activities according to your personal capacity and interest. You can do that easily by contacting the chairpersons of the respective Committee.

On behalf of the new Executive Board, I would like to thank you very much for all your contributions in previous years, particularly to the members of the previous Executive Committee and specifically to the retiring Executive Board members; Professors Christophe Cognard and Isabel Wanke.

Wishing you great success and satisfaction in working with the ESMINT community,

Sincerely yours,

Istvan Szikora
President

Download PDF version

ESMINT introduces the new educational strategy of the Society
5 September, 2014 - 14:58

Starting in December 2014, under the name of European Course in Minimally Invasive Neurological Therapy (ECMINT) ESMINT will be organizing a series of residential training courses in partnership with the Oxford Neurovascular and Neuroradiology Research Unit (ONNRU), Oxford University.

> More information and registration

The ESMINT Teaching Course established in 2006 by Isabel Wanke and Daniel Rufenacht, and being held in the past years in December in Barcelona will continue in the future as Advanced NeuroInterventional Course (ANIC, www.anic2014.org).

About the Course

The European Course in Minimally Invasive Neurological Therapy (ECMINT) intends to teach trainees in Intervention Neuroradiology all the elements of the specialty curriculum as defined by the Neuroradiology subsection of the European Union of Medical Specialist (UEMS): will be covered in the first cycle. The first cycle will comprise 4 courses to be held at St Anne’s College, Oxford.

The dates of the first Cycle of ECMINT will be:-

ECMINT 1: 15th to 19th December 2014.
ECMINT 2: 24th to 28th June 2015
ECMINT 3: 14th to 18th December 2015
ECMINT 4: 21st to 25th June 2016

Final Course details and Registration will be available at the Annual Congress in Nice in next month. Places will assigned on a first come basis to members of ESMINT and early registration is advised because they will be limited to ensure that students receive the highest quality teaching experience.
 

Participate in new survey to update guidelines for acute stroke patients
16 June, 2014 - 16:41

STIR/VISTA Imaging is conducting a new survey to collect information about the imaging and treatment decisions that are typically made in standard acute patients in centres across the world. If you wish to participate in the survey please click on the link below.

http://www.surveygizmo.com/s3/1599227/Clinical-Case-Vignettes

As a result of the survey updated guidelines for imaging and treatment decisions in acute stroke will be published. The results will also be discussed at the next meeting, Thrombolysis and Thrombectomy in Acute Stroke Treatment (TTST), October 18-20 in Heidelberg\Mannheim.

We hope you will share the link with your colleagues, thank you if you have already participated.

New issue of the Neurointerventional Newsletter
9 June, 2014 - 08:05

The May 2014 issue of the Neurointerventional Newsletter is now available for download by clicking the button below.

Download - Neurointerventional Newsletter, May 2014

Provided to ESMINT by Prof Michael Forsting & Stryker Neurovascular

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