New Advances May Treat Stroke Faster, Better

Innovations include 'brain stents' and a clot-busting drug delivered directly to the brain

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By Kathleen Doheny
HealthDay Reporter

FRIDAY, Feb. 20 (HealthDay News) -- Tiny tubes called stents, used for years to open blocked coronary blood vessels, may also work well to reopen brain blood vessels clogged from strokes, according to new research.

A variety of other advances promise to improve stroke treatment or prevention as well, a panel of researchers said. Among the developments, presented Thursday at the International Stroke Conference in San Diego:

  • Using new delivery systems to make a medication more effective in breaking up clots in the brain;
  • Finding new genetic clues to predict who might develop an aneurysm, a weakened brain blood vessel that can rupture and cause a devastating hemorrhagic stroke;
  • Treating people who have low cholesterol levels but elevated levels of a stroke-linked inflammatory marker with the anti-cholesterol drug Crestor, which nearly halved users' risk for stroke in a recent trial.

First, the stent research. According to Dr. J. Mocco, clinical assistant professor at the University at Buffalo, N.Y., the use of a tiny, self-expanding stent seems to be an effective and safe way to reopen blood vessels blocked after an ischemic stroke. Ischemic strokes make up the majority of attacks and occur when a blood vessel is blocked.

The FDA-approved pilot study involved 20 stroke patients averaging 63 years of age, all of whom had no blood flow through the affected brain blood vessel after the stroke. However, after the stent was put in place, "all had adequate blood flow," Mocco said.

Some also received the powerful clot-busting drug tissue plasminogen activator (tPA), in use since 1996. While the time window for tPA usefulness is within three hours of the onset of stroke symptoms, Mocco said he achieved success in reopening vessels when inserting stents up to about eight hours after the onset of stroke symptoms.

Stroke-linked disability also lessened with the use of the stents, he added. "Forty-five percent of the patients achieved complete independence," Mocco said. Other stents have been studied in the brain, he said, but Mocco believes this is the first study to follow patients over time.

Next up came a study investigating the use of ultrasound to boost the effectiveness of tPA. Dr. Andrei Alexandrov, director of the Comprehensive Stroke Center at the University of Alabama in Birmingham, said his team is working to refine the technique.

"Ultrasound energy amplifies the energy of the tPA," Alexandrov explained. In his clinic, he is using ultrasound waves to push tiny, gas-filled fat microspheres containing a contrast agent through the blocked arteries to help reopen the vessels. "The microspheres help tPA continue its mechanical action," the researcher explained.

Comparing 35 patients treated with the microspheres plus tPA or tPA alone, 67 percent of those who got the low dose of microspheres had reopened vessels 36 hours later, compared to 33 percent of those who got tPA alone. Disability seemed reduced as well: 75 percent of those receiving the low-dose ultrasound-boosted treatment had little or no disability within three months of treatment compared to 36 percent of those who got tPA alone. The study was funded by ImaRx Therapeutics, Inc., the maker of the technology.

In other research, using a catheter to deliver tPA for treating brain bleeds was effective in patients with an intracerebral hemorrhage, or bleeding inside the brain. Using tPA to counter a bleed appears "counter-intuitive," acknowledged the lead researcher, Dr. Daniel F. Hanley, a neurology professor at Johns Hopkins Hospital in Baltimore. That's because the clot-buster is meant for ischemic strokes, in which the vessel clogs from within due to a clot, not hemorrhagic strokes, in which the vessel bursts and blood escapes.

However, bleeding within the brain's internal cavities poses its own clotting risk. After someone suffers an intracerebral hemorrhage, clots can form in the areas that fill with blood, Hanley explained. Delivering tPA via catheter to these regions can help dissolve the clots.