The Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times (ESCAPE) is a multicenter, randomized, controlled trial assessing endovascular treatment as compared with guideline based standard of care. Using data from that study, the authors sought to determine the efficacy of endovascular therapy in patients with acute ischemic stroke and proximal anterior circulation occlusion.

Subjects presenting within 12 hours of stroke onset with pre-specified neurovascular imaging criteria were studied. All underwent follow-up imaging at 24 and 48 hours from stroke symptom onset. The data were reviewed for differences in stroke volume between treatment groups (endovascular and standard of care) and between subjects who did and who did not achieve early recanalization.

The median post-treatment infarct volume in all subjects was 21 mL, with the median infarct volume in the endovascular group of 15.5 mL and that in the control of 33.5 mL (P<0.01). Early recanalization occurred in 72% of those in the endovascular group and 31% in the control group. Baseline NIHSS, Alberta Stroke Program Early CT score [ASPECTS], and recanalization status were independently associated with posttreatment infarct volume (P<0.01 for all comparisons).

This study, using data from the ESCAPE trial showed that endovascular treatment among subjects with acute ischemic stroke and proximal anterior circulation occlusion is associated with smaller infarct volumes.