SA Health_ 29th October 2022
29 Oct 2022
A world-leading stroke trial investigating early keyhole brain surgery to treat intracerebral haemorrhage (ICH), or bleeding into the brain, is being expanded across the country and internationally.
On World Stroke Day, the latest phase of the EVACUATE study has seen the trial progress to major stroke centres around the world, treating dozens of patients impacted by stroke.
Stroke is the second leading cause of death and the leading cause of serious long-term disability worldwide, and one in five Australians will suffer from a stroke in their lifetime.
ICH is the most devasting type, accounting for around 15 per cent of all strokes but because of its severity causes around one in 20 deaths worldwide, with severe disability in the majority of survivors.
The EVACUATE study, led by the Royal Melbourne and Royal Adelaide Hospitals, examines whether early minimally invasive brain surgery in patients who present with large haemorrhages can achieve the best outcome for patients.
The process involves prioritising patients presenting with ICH for immediate surgery. The surgical team then uses a technique to drill a small hole in the patient’s skull so a probe can be inserted into the brain. From there, the surgeon is guided by cross-section images of the brain, to locate the area of bleeding and remove the blood clot to stop vessels from bleeding.
If performed early enough, this stops the expansion of the bleed and reverses the toxic effects of blood in the brain.
The current phase of the study is randomised and patients either receive the surgery or the usual treatment, which generally involves medication and close monitoring in the stroke unit.
To determine which group has the best outcomes, each patient’s functional quality of life is assessed at six and 12 months after stroke by a ‘blinded’ assessor who does not know if the patient has received surgery or the standard treatment.
This ‘surgical efficacy’ phase of the EVACUATE study is expected to be completed in March, and from there, assuming success, it will transition to the next phase which would incorporate hundreds more stroke patients.
The Medical Research Future Fund supports the EVACUATE study with funding of $2.1 million.
World Stoke Day aims to raise awareness of the signs of stroke and the need for timely access to quality stroke treatment.
More information on World Stoke Day can be found here: https://www.world-stroke.org/world-stroke-day-campaign
Statement attributable to RAH Neurosurgeon and Surgical Principal Investigator, Associate Professor Amal Abou-Hamden:
When people experience these types of stokes it’s like a bomb has gone off in their brain. The bleeding devastates the central region where the bleeding occurs and can expand over several hours.
This non-invasive surgery uses a small probe so we can avoid damaging the healthy tissue of the brain and suck out the clot as quickly as possible.
The surgery can take as little as 15 minutes and stops the bleeding from getting any worse, which might not only prevent major disability, but also be lifesaving.
Previous phases of the study have shown positive results and the current phase appears just as promising.
Our hope is that one day this technique will become easily accessible, not just at specialist units, but at hospitals right across Australia and the world.
Statement attributable to Central Adelaide Local Health Network (CAHLN) CEO, Professor Lesley Dwyer:
This is an exciting trial that has the potential to lead to major improvements to stroke systems of care and deliver real benefits to stroke patients and their families across the world.
We are incredibly proud of our stroke team for leading this world class research, which highlights our commitment to developing new and innovative treatments that deliver safe, effective, and improved care.
