A transformative $25.9 million grant from The Marcus Foundation will accelerate pioneering research aimed at revolutionizing hemorrhagic stroke treatment.  This major 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 ambitious 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. 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.

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. 

“This grant, believed to be the largest philanthropic award ever made for clinical research targeting fatal stroke intervention, underscores the long-standing partnership and commitment of The Marcus Foundation in supporting lifesaving stroke research. Their continued investment has been crucial in driving breakthroughs that offer new hope to patients,” says Michael Frankel, MD, chief of neurology and director of the Marcus Stroke and Neuroscience Center for Grady Health System. He is also a professor of neurology and division director of vascular neurology at Emory University School of Medicine.

“After witnessing the staggering death and disability strokes cause, I knew we had to do more to discover new treatment options,” says Bernie Marcus, founder of The Marcus Foundation and co-founder of The Home Depot. “Breakthroughs like this new approach for the deadliest form of stroke and others made by the stellar team at the Marcus Stroke & Neuroscience Center will save and change lives around the world for decades. That's a remarkable philanthropic return on investment.”

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.

Pivotal stroke research led by the Emory/Grady team 

1992-1996

NINDS tPA Stroke Trial: Clinical trial that changed the standard of care for patients with acute ischemic stroke establishing the benefit of the intravenous clot busting medication called tissue plasminogen activator (tPA). Published in New England Journal of Medicine in 1995 and 1999. 

2001-present

Paul Coverdell Acute Stroke Registry: Established by the CDC to be state-based registries collecting data to improve stroke care focusing on timely treatment with intravenous tPA. Georgia was one of the first states to receive funding.

2014–2017

DAWN Trial: Clinical trial that changed the standard of care for patients with ischemic stroke by proving the efficacy of thrombectomy (mechanical clot retrieval). Published in the New England Journal of Medicine in 2018. 

• DAWN highlighted in an episode of Your Fantastic Mind on PBS/Georgia Public Broadcasting

2016–2023

ENRICH Trial: Randomized, multicenter clinical trial establishing benefit of MIPS for patients with ICH in the brain’s lobar region and is expected to change the standard of care for this disease. Published in the New England Journal of Medicine in 2024.

• ENRICH highlighted in an episode of Your Fantastic Mind on PBS/ Georgia Public Broadcasting

• Additional details and a video of MIPS, PR Newswire

Stroke and The Marcus Foundation 

2008

Marcus Stroke and Neuroscience Center: Based at Grady Hospital in downtown Atlanta, the Marcus Center is staffed by faculty physicians from Emory and Morehouse School of Medicine and directed by Michael Frankel, MD.

2017

Expansion of the Marcus Stroke and Neuroscience Center:  Specifically designed to optimize inpatient/outpatient continuity for multi-disciplinary neuroscience care, the Marcus Stroke and Neuroscience Center Outpatient Clinic opened its doors to serve more patients and expand research capabilities.

2018-present

Marcus Stroke Network: Designed to reduce stroke disability and death rates in the “stroke belt” Southeast. Collaboration among Marcus Stroke and Neuroscience Center at Grady Hospital, Emory Brain Health Center, Marcus Neuroscience Institute at Boca Raton Regional Hospital in Florida and the American Heart Association. Also offers Georgia’s first mobile stroke unit. And provided support to add a second neuro-angiography suite to the Marcus Stroke and Neuroscience Center, the first center in the U.S. to embed an angiogram suite into the neurocritical care setting, thereby improving the efficiency and safety of care.

2024–2028

REACH Trial: This multicenter clinical trial will test MIPS for patients with ICH in the brain’s anterior basal ganglia.