Research aims to limit the damaging effects of stroke

Ted J Lowenkopf

Ted J. Lowenkopf, M.D.
Neurologist and medical director, Providence Stroke Center

March 3, 2014

Stroke is the third leading cause of death in the United States and the leading cause of disability. New clinical trials on both acute ischemic and hemorrhagic strokes hold promise for reducing the magnitude of these grim statistics. 

Here are a few innovative trials in which Providence Stroke Center, part of the Providence Brain and Spine Institute, is taking part:

Acute ischemic stroke
SWIFT-PRIME: Tissue plasminogen activator, or tPA, is the only U.S. Food and Drug Administration-approved treatment proven to reduce the disability associated with acute stroke.

Intravenous infusion of the clot-dissolving agent remains the standard of care for acute ischemic stroke, but in recent years clot-removal devices delivered through a catheter have been shown to be safe and effective for clearing blocked arteries. To date no studies have measured the effects these minimally invasive treatments have on functional outcomes following a stroke.

This study compares functional outcomes in acute stroke patients treated with IV-tPA alone versus those treated with IV-tPA plus a stent catheter clot-retrieval device.

ACTION: A significant degree of brain injury from ischemic stroke occurs in a delayed fashion from immune system mediated inflammation. This randomized placebo-controlled study borrows a proven drug used for multiple sclerosis patients, natalizumab, and tests it in acute stroke patients. Researchers are hoping to learn if an immunomodulatory drug will reduce disability by decreasing the damage caused by inflammation.

Hemorrhagic stroke

MISTIE-III: It is well established that an enlarging brain hemorrhage may cause death or severe disability and that even a stable hemorrhage can cause life-threatening swelling. It remains unclear, however, whether it’s better to manage smaller hemorrhages through medical monitoring or through an intervention.

In this study, patients are randomized to receive either medical monitoring or a minimally invasive procedure that involves placement of drainage catheters followed by infusion of tPA directly into the clotted hemorrhage. The study hopes to prove whether faster clot resolution improves functional outcomes and reduces death and disability.

CLEAR-III: Brain hemorrhage is particularly lethal when blood extends into the cerebral ventricles. This study infuses tPA into the ventricles to determine if faster clot resolution improves functional outcomes and reduces death and disability over standard drainage treatments.

ATACH-II: Hypertension in patients with acute brain hemorrhage is associated with hemorrhagic expansion and worse outcomes. However, there is no international standard for blood pressure parameters when treating these patients.

This study randomizes patients with acute brain hemorrhage into two different blood-pressure control ranges and compares the clinical outcomes. 

Aneurysm Wall Histology registry: This study analyzes nonruptured aneurysms to determine what histological and structural features predict the likelihood of rupture. If successful, the methodology will enhance the ability to predict which aneurysms require surgical or endovascular intervention and which can be managed without a procedure.

Stroke prevention
POINT: A longstanding question in stroke prevention has been which antiplatelet medications are best for stroke prevention. Patients with acute TIAs (transient ischemic attacks) or those with small strokes are at particularly high risk of having a larger stroke within three months of the initial event.

In this study, patients receive either aspirin alone or a combination of aspirin and clopidogrel (brand name Plavix) and are followed for 90 days. The study seeks to determine whether the combination of daily aspirin and clopidogrel is superior to aspirin alone in reducing the stroke rate in the first 90 days after patients who have just had a TIA or very small strokes

To learn more about these trials or to refer a patient, contact Ted Lowenkopf, M.D., or Monica Rodriguez, RN, CCRP, at 503-216-1015.