Subject : Clinical trials / Medical discoveries
Enabled by the Montpellier University Hospital teams with the international study IN EXTREMIS- LASTE, published Thursday May 8 in the New England Journal of Medicine
The brain that we thought was dead is not!
MONTPELLIER, France, May 9, 2024 /PRNewswire/ — LePr Vincent Costalat (neuroradiologist) and Dr Caroline Arquizan (neurologist) from Montpellier University Hospital have just revolutionized the management of stroke by coordinating an international therapeutic clinical study published in the most prestigious medical journal in the world: The New England Journal of Medicine.
Trial of Thrombectomy for Stroke with a Large Infract of Unrestricted Size, published in the New England Journal of Medicinehttps://www.nejm.org/
Since the validation in 2015 of cerebral revascularization (thrombectomy) techniques for stroke patients, neurologists and interventional neuroradiologists selected only patients for whom medical imaging showed a limited portion of cerebral destruction, following the principle that reperfusion of the arteries of the brain allowed only the unaffected tissue to survive and bring about functional recovery, the rest being given up for death.
Surprising results
However, it is quite the opposite that the teams from the Montpellier University Hospital demonstrated.
The establishment sponsored a multicenter therapeutic trial In EXTREMIS-LASTE (Large Stroke Treatment Evaluation), carried out in France (26 centers) and in Spain (7 centers) coordinated by Professor Vincent Costalat (neuroradiologist) and Dr. Caroline Arquizan (neurologist) from Montpellier University Hospital, in collaboration with Dr. Bertrand Lapergue (Foch Hospital, Paris) and Professor Tudor Jovin (Cooper, University Hospital, NJ, United States).
The objective of this study was to select patients considered too severe or considered unrecoverable in daily practice, and to test the hypothesis that reperfusion of brain tissue considered dead could change their vital prognosis but also their functional recovery.
To the great surprise of the entire international medical scientific community, the therapeutic trial In EXTREMIS-LASTE carried out on 333 patients included in France and in Spain proved very strongly positive with a reduction in the absolute risk of death of 20% and a surprising functional improvement bringing 1 in 5 patients home after 6 months of rehabilitation!
The discovery is of major importance since, with the results of the LASTE study, almost 20% of stroke patients who were not considered eligible for emergency revascularization treatment (within the first 7 hours) are today with a major therapeutic effect, since it is enough to treat 4 patients to observe a clinical benefit, whereas the treatment of myocardial infarction requires almost 35!
The IN EXTREMIS LASTE and MOSTE therapeutic trials received co-financing in the form of a research grant financed by 5 manufacturers (BALT, CERENOVUS, MICROVENTION, MEDTRONIC, STRYKER).
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