A Melbourne research trial has paved the way for improved outcomes for stroke patients.
EXTEND-IA TNK investigated the impact of clot busting drug tenecteplase – the current recommended clot dissolving treatment for heart attack patients – prior to clot retrieval surgery in patients with stroke due to a large blocked blood vessel in the brain.
Stroke Foundation Clinical Council Chair Associate Professor Bruce Campbell led the trial with neurointerventionist Prof Peter Mitchell, and said its results brought new hope to stroke patients.
“Medical treatment is time-critical after a stroke. A stroke happens when blood supply to the brain is interrupted,’’ A/Prof Campbell said.
“The faster blood flow can be restored in the brain, the fewer brain cells die and the better the chance of recovery.
“We administered tenecteplase to more than 200 ischemic stroke patients with strokes caused by large clots, whose next treatment step was having clot retrieval surgery (endovascular thrombectomy).
“One in five patients, treated with the drug, had blood flow rapidly restored and no longer required clot retrieval,” he said.
Stroke Foundation Chief Executive Officer Sharon McGowan said the new drug had the potential to save lives and reduce acquired disability from stroke, particularly for regional Australians who have limited access to clot retrieval treatment.
“The outcomes of the trial are fantastic,’’ Ms McGowan said.
“Regional Australians are 19 percent more likely to have a stroke than their city counterparts.
“They are also less to have access to the latest in stroke treatments as neurologists and hospitals delivering clot retrieval treatment are primarily in our metropolitan areas.
“We now must ensure this latest research is translated into clinical practice and ensure all Australians have access to it.”
Tenecteplase doubled the number of patients who had blood flow restored to the brain earlier than is possible with clot retrieval surgery (22 percent vs 10 percent) and improved patient outcomes.
A/Prof Campbell said the drug has practical advantages as it is delivered over 10 seconds instead of 1 hour, facilitating easier transfer of patients between hospitals for treatment. It is also less expensive.
This research will now be reviewed and considered as part of an update to the Australian Clinical Guidelines for Stroke Management. It will also reach an international audience through publication in the prestigious New England Journal of Medicine, potentially changing the way stroke is treated.
The EXTEND-IA TNK randomised trial was led by The Royal Melbourne Hospital and University of Melbourne and involved 13 hospitals in Australia and New Zealand. It built on the EXTEND-IA trial, concluded in 2015, and partly funded by the Stroke Foundation Research and Innovation Fund, which saw clot retrieval treatment adopted as best practice.
Ms McGowan said Australian researchers were leading the way in new innovations in stroke treatment.
“Tragically, it’s estimated there will be more than 56,000 strokes across the country in 2018 – that is one every nine minutes. Too many Australians are dying or being left with an ongoing disability as a result of stroke,’’ she said.
“Stroke is largely preventable and treatable. High quality evidence-based research will help us stop this terrible disease and reduce the spiraling costs to the community and health system associated with stroke.
“These researchers give us hope for the future,” she said.
(Source: Stroke Foundation)