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Return to Optimizing the Treatment of Acute Ischemic Stroke Overview

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Return to Optimizing the Treatment of Acute Ischemic Stroke Overview

More on Optimizing the Treatment of Acute Ischemic Stroke

Optimizing the Treatment of Acute Ischemic Stroke

NEW YORK (Aug 1, 2012)

Phillip M. Meyers, M.D., F.A.H.A.
Phillip M. Meyers, M.D.,

They say time is money. But in the world of stoke care, time is survival – so much so that "time is brain" has become the mantra of stroke specialists. That's because the longer blood supply to brain tissue is impaired, the higher the likelihood of irreversible brain damage.

When a stroke occurs, the brain suffers damage that can set off a cascade of related complications – like elevated pressure inside the skull, seizures, and fever – which amplify injury to the brain and lessen the patient's chance of a full recovery. Getting the best available care within the first 48 hours of a stroke (and especially within the first three hours) can halt this cascade and is critical to making the best possible recovery.

Ischemic stroke occurs when a clot blocks a vessel supplying oxygen-rich blood to the brain. Eighty-eight percent of the 750,000 strokes that occur among Americans each year are ischemic. When used within three hours of stroke onset, the drug "tissue plasminogen activator" (tPA) may be effective for breaking up the clot.

Treatment Options Are Being Evaluated

But just what kind of care is needed for patients with severe ischemic strokes, such as those caused by blood clots in large vessels, remains the subject on ongoing research. It is well known that patients with strokes affecting the larger arteries respond relatively poorly to intravenous treatment with tPA. Is tPA enough, or should a special endovascular device also be inserted to break up and remove the clot (a procedure called thrombectomy)?

"We have the means to re-open cerebral arteries at the time of an acute stroke. What we don't yet know is how to identify which patients will benefit from the procedure and which will not. Inappropriately performed, thrombectomy can cause further harm," explained Philip M. Meyers, M.D., F.A.H.A., the Co-Director of Neuroendovascular Services at New York Presbyterian/Columbia University Medical Center. "We need to learn who endovascular treatment is most appropriate for and who is most likely to get better with these approaches."

Dr. Meyers describes how the Neuroendovascular Service at NYP helps patients with stroke and other vascular problems such as vascular malformations.

Clinical trials are seeking to determine if patients with blockages in large arteries fare better if endovascular techniques – which employ devices inserted into the blocked artery through a catheter – are used. The catheter is inserted into the femoral artery in the groin and threaded up to the blocked artery in the brain, where the device is deployed. The newest devices are "stent retrievers." With one such approach, a self-expanding stent-like device is connected to a wire; the stent opens, the clot adheres to it, and the stent can be pulled out, taking the clot with it.

Prevention Methods Being Evaluated As Well

Preventing strokes from ever occurring and treating them early when they do are still key. NewYork-Presbyterian Hospital/Columbia University Medical Center is a site for the SPOTRIAS (Specialized Program of Translational Research in Acute Stroke) Network, a multicenter collaboration of U.S. stroke centers conducting major stroke research which is supported by the National Institute of Neurological Disorders and Stroke. One study, called SWIFT, aims to determine the effectiveness of an interactive stroke educational program compared to standard educational materials and usual care to increase stroke knowledge and improve emergency room arrival times after stroke symptoms begin. A second study, Neu-START, is evaluating the optimal dose of the drug lovastatin (a cholesterol-reducing medication) for the treatment of acute ischemic stroke.

"Endovascular stroke treatment is rapidly evolving and remains an area of active research," Dr. Meyers concluded. He advised that the best stroke care is available at comprehensive stroke centers. "Data have shown that the more experience a center has in treating patients with stroke, the better the outcomes."

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