Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

New research pinpoints best treatment for stroke

20.04.2005


Results suggest CT perfusion improves outcomes



Interventional neuroradiologists at West Virginia University School of Medicine and Hospitals today presented the largest study to date on the utility of computed tomography (CT) perfusion imaging of the brain in determining and predicting stroke outcomes. Results will help better identify patients who are suitable candidates for treatment utilizing either clot busting medicines or clot retrieval devices. The research was presented to leading neurosurgeons at the 73rd annual meeting of the American Association of Neurological Surgeons.

The research, which examined 705 stroke patients, is significant because it allows doctors to customize stroke treatments based on the degree of brain death, instead of relying solely on how soon or late a patient comes to the hospital after having stroke symptoms. Stroke is the third leading cause of death among Americans. According to the American Stroke Association, 700,000 people each year experience a stroke. WVU researchers believe this research could change national protocols on how stroke patients are triaged and potentially extend treatment opportunity beyond the three-to-six hour window.


Under NIH stroke guidelines, hospitals typically administer tPA (a clot-busing drug) to patients within a three-hour window of stroke onset. After six hours, it’s generally considered too risky to administer even interarterial clot busting medicines, due to the risk of a potentially deadly hemorrhage.

But research presented by interventional neuroradiologists Jeff Carpenter, M.D., and Ansaar Rai, M.D., Assistant Professors at The Department of Neurological Surgery of West Virginia University School of Medicine, suggests more lives might be saved and debilitating side effects minimized if treatment of stroke patients was based on qualitative and quantitative imaging such as CT perfusion and CT angiography and not on generalized application of arbitrary time windows of three of six hours.

Those windows can exclude some patients who may benefit from treatment and include others who may suffer from serious complications of the treatment. Application of his research could increase the time window of treatment for stroke patients to greater than seven hours. This is significant because patients often don’t present to hospitals until after the three-hour window has closed because they don’t recognize the symptoms of stroke, can’t summons help quickly, or reside in rural areas. Additionally, those that do present in time can receive treatment that results in hemorrhage. A 2003 study published in Stroke which analyzed 15 published reports of tPA use in more than 2600 acute stroke patients found the intracerebral hemorrhage rate was 5.2 percent.

The WVU study shows that CT perfusion, which measures blood flow, is very accurate at determining which patients would best benefit from treatment and which should not receive clot-busting drugs. In the study, less than one percent of patients suffered a hemorrhage after receiving tPA, compared with the average of 5.2 percent of patients cited by the Stroke study.

CT perfusion allows radiologists to determine which portions of a stroke patient’s brain are dead, and which portions are dying but capable of being salvaged. Once a ratio of dead to dying brain is calculated, doctors can determine the best course of treatment. Only those patients whose brains are damaged but still alive will benefit from that treatment of acute revascularization of a blocked blood vessel.

To determine accuracy of CT perfusion, patients received both CT perfusion and an MRI. Results of the study presented shows that CT perfusion results correspond exceedingly well to MRI studies on several parameters including measuring cerebral blood volume, which indicates the severity of a blockage. About 60 percent of patients deemed candidates for intervention following CT perfusion were able to have their clots removed successfully by interarterial administration of tPA and the MERCI (corkscrew) procedure. In MERCI, the blood clot causing the stroke is removed by threading a corkscrew-like device through a catheter fed through the groin.

While MRIs are considered the gold standard for post stroke analysis, they are rarely performed and generally impractical because: they take 30 minutes to perform, require a stroke patient to be still to capture clean images (the patient may be moving or thrashing), require doctors to check for metal in the patients body (which may be impossible if no family members are present) and the MRI units themselves are often not adequately staffed or not located near the emergency room.

CT perfusion offers distinct advantages because most hospital emergency rooms use them frequently for other purposes, they take one to two minutes to scan (versus 30 minutes for MRI), and provide clear images even if a patient cannot lie perfectly still. Most hospitals need only to buy software (at a relatively inexpensive cost) to upgrade their systems and institute training programs.

In the coming months, Drs. Carpenter and Rai are expecting to publish their study in a nationally recognized journal.

Paul Moniz | EurekAlert!
Further information:
http://www.widmeyer.com

More articles from Studies and Analyses:

nachricht A sudden drop in outdoor temperature increases the risk of respiratory infections
11.01.2017 | University of Gothenburg

nachricht Urbanization to convert 300,000 km2 of prime croplands
27.12.2016 | Mercator Research Institute on Global Commons and Climate Change (MCC) gGmbH

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

Im Focus: How to inflate a hardened concrete shell with a weight of 80 t

At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).

Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...

Im Focus: Bacterial Pac Man molecule snaps at sugar

Many pathogens use certain sugar compounds from their host to help conceal themselves against the immune system. Scientists at the University of Bonn have now, in cooperation with researchers at the University of York in the United Kingdom, analyzed the dynamics of a bacterial molecule that is involved in this process. They demonstrate that the protein grabs onto the sugar molecule with a Pac Man-like chewing motion and holds it until it can be used. Their results could help design therapeutics that could make the protein poorer at grabbing and holding and hence compromise the pathogen in the host. The study has now been published in “Biophysical Journal”.

The cells of the mouth, nose and intestinal mucosa produce large quantities of a chemical called sialic acid. Many bacteria possess a special transport system...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

Nothing will happen without batteries making it happen!

05.01.2017 | Event News

 
Latest News

Water - as the underlying driver of the Earth’s carbon cycle

17.01.2017 | Earth Sciences

Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

17.01.2017 | Materials Sciences

Smart homes will “LISTEN” to your voice

17.01.2017 | Architecture and Construction

VideoLinks
B2B-VideoLinks
More VideoLinks >>>