The Marcus Foundation has granted $25.9 million to Emory University School of Medicine and Grady Health System’s Marcus Stroke and Neuroscience Center to fund the Rapid Evacuation and Access of Cerebral Hemorrhage (REACH) trial and its companion registry. This initiative aims to revolutionize the treatment of hemorrhagic stroke, particularly intracerebral hemorrhage (ICH).
Addressing a Critical Unmet Need in Deep ICH
ICH, a severe form of hemorrhagic stroke, affects approximately 3.4 million people globally each year. It occurs when a ruptured vessel bleeds directly into brain tissue, causing significant damage and disrupting vital brain functions. Current treatment options are limited, especially for deep ICH, highlighting a critical unmet medical need.
Gustavo Pradilla, MD, a neurosurgeon at Emory University and Grady Health System, emphasized that there is currently no proven standard of care for surgically treating ICH in the basal ganglia. The REACH trial seeks to address this gap by investigating the use of minimally invasive parafascicular surgery (MIPS) for deep ICH within the anterior basal ganglia, a challenging and commonly affected area.
Building on the Success of the ENRICH Trial
The REACH trial builds on the success of the national ENRICH trial, which demonstrated the effectiveness of MIPS for ICH in the brain’s lobar region. Published in the New England Journal of Medicine in April 2024, the ENRICH trial marked a significant advancement in ICH treatment. While MIPS has shown promise for lobar ICH, medical management remains the standard approach for deeper hemorrhages, as conventional surgery often prevents death but does not improve long-term disability outcomes.
Study Design and Objectives of the REACH Trial
The REACH trial will enroll approximately 600 patients at up to 60 stroke centers nationwide over four years, with enrollment targeted to begin in December 2024. MIPS offers a less invasive alternative, utilizing advanced computerized brain mapping and small instruments to remove clots and control bleeding. The procedure requires a smaller opening in the skull than a conventional craniotomy, allowing for higher rates of clot removal and control of the bleeding source without damaging surrounding tissue.
In addition to optimizing the MIPS technique and demonstrating its safety and efficacy, REACH will establish new guidelines for treating patients with ICH in the brain’s basal ganglia. The accompanying REACH registry will build a comprehensive data repository, guiding future clinical practices and promoting broader adoption of MIPS for patients with spontaneous ICH. Like ENRICH, the REACH trial will utilize FDA-cleared technology to access and evacuate the hematoma and a standardized approach in addition to guideline-based medical management.
The Impact of Stroke and the Role of the Marcus Foundation
Stroke remains a significant public health issue, with up to 50% of hemorrhagic stroke patients dying within 30 days and only 25% of survivors regaining full independence. The financial burden is equally severe, costing the U.S. health care system approximately $17 billion annually, with $12 billion attributed to care and productivity losses for survivors.
Since 2008, The Marcus Foundation has awarded more than $72 million to the Emory/Grady team to advance stroke research, prevention, and treatment. Their initial grant was instrumental in establishing thrombectomy as a key treatment for mechanical removal of blood clots in the brain.
Michael Frankel, MD, chief of neurology and director of the Marcus Stroke and Neuroscience Center for Grady Health System, noted that this grant is believed to be the largest philanthropic award ever made for clinical research targeting fatal stroke intervention. Bernie Marcus, founder of The Marcus Foundation, emphasized the importance of discovering new treatment options to save and change lives around the world.
