A $25.9 million grant from The Marcus Foundation will accelerate pioneering research aimed at revolutionizing hemorrhagic stroke treatment.
The award will fund the Rapid Evacuation and Access of Cerebral Hemorrhage (REACH) trial and its companion REACH registry, led by Emory University School of Medicine and Grady Health System’s Marcus Stroke and Neuroscience Center.
The REACH trial will explore treatment for intracerebral hemorrhage (ICH), a severe form of hemorrhagic stroke where bleeding from a ruptured vessel occurs directly within the brain tissue, causing severe damage to brain cells and disrupting vital brain functions. Affecting approximately 3.4 million people globally each year, these strokes are the deadliest and most debilitating, with significant health and economic impacts. Despite medical advancements, current treatment options are limited, especially for deep ICH.
Building on the success of the national ENRICH trial, which demonstrated the effectiveness of minimally invasive parafascicular sugery (MIPS) for ICH in the brain’s lobar region, and published in April 2024 in the New England Journal of Medicine, the REACH trial seeks to further these advancements. This study will be the first to investigate the use of MIPS for deep ICH, particularly within the anterior basal ganglia, a challenging and more commonly affected area.
Gustavo Pradilla, MD, a leading neurosurgeon at Emory University and Grady Health System, emphasizes the significance of the REACH trial.
“This initiative represents a significant step forward to advance hemorrhagic stroke treatment,” Pradilla said in a press releae. “By refining the MIPS technique and expanding its use to the basal ganglia, we aim to transform the standard of care for patients with spontaneous ICH, improving outcomes and reducing the devastating impact of this condition.”
Pradilla, co-principal investigator for REACH, is a professor of neurosurgery at Emory University School of Medicine and chief of neurosurgery at Grady Health System.
According to Pradilla, there is currently no proven standard of care for surgically treating ICH in the basal ganglia, as no clinical trial has demonstrated the effectiveness of such interventions.
While MIPS represents a paradigm shift for ICH in the lobar region, closer to the brain’s surface – as established in the ENRICH trial – medical management remains the approach for deeper hemorrhages, since conventional surgery prevents death but does not improve long-term disability outcomes.
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, using 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 and allows 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 additional to guideline-based medical management.
In addition to Pradilla, the REACH trial principal investigators include Jonathan Ratcliff, MD, MPH, associate professor of emergency medicine at Emory University School of Medicine and director of neurocritical care at Grady Health System, and Alex Hall, DHSc, MS, assistant professor of emergency medicine and director of clinical trials at the Emory Neurosciences Lab and Trial Operations Core, Emory University School of Medicine.
“We are profoundly grateful to The Marcus Foundation for this monumental award, which reaffirms the power of collaborative, visionary support in addressing one of the world’s most critical health challenges. REACH has the potential to significantly improve treatment options for stroke patients, both in Georgia, where stroke remains a leading cause of death, and far beyond,” says Ravi Thadhani, MD, MPH, executive vice president for health affairs at Emory University.
