pulse
SPRI NG
2003
CHANGING THE COURSE OF
STROKE BY MARYANN B. BRINLEY
T
he campaign has been quietly gathering momentum. A small army of stroke specialists is now in Newark to put a stop to the number three cause of death and the leading reason for disability in the United States. “Stroke is life-threatening and 30 percent of people who develop one, die. But quite apart from that, we accept disability from stroke too easily. It really wrecks somebody’s future and creates havoc in families. Even physicians don’t have the empathy or insight into this. We have the treatment for this,” says Patrick Pullicino, MD, PhD, New Jersey Medical School (NJMS) neurosciences chair. Generating millions of research grant dollars, NJMS and University Hospital (UH) have recruited neuro-interventionalists, neurologists, stroke-intensivists, laboratory and clinical researchers, and support staff to help win the race. Within UH, interventional neuro-radiologists and cardiologists are also joining forces to change the course of strokes and improve chances of survival and recovery without disability.
AT THE ACUTE STAGE
S
tep into the cerebrovascular angiography suite at UH where the speed stroke demands will send you flying to the center of a patient’s brain. According to the National Institute of Health’s (NIH) guidelines for acute ischemic stroke, there is a “golden hour” of rapid identification and treatment essential to saving lives. The NJMS-UH team has done this in half the time recommended by the NIH and with more accuracy.
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PULSE
SPRI NG
2003
A stroke occurs when blood flow to an area of the brain is interrupted, cutting off oxygen and nutrients to the tissue (ischemic), or when a vessel breaks and spills blood into the surrounding cells (hemorrhagic). Both kinds of stroke create a cascade of biochemical disasters that call for the fastest response possible because the longer brain tissue remains under attack, the more likely the person is to die or suffer serious side effects. If there is one message about stroke that has been hammered repeatedly to physicians and broadcast to the public, it is this window of treatment opportunity: from zero to three hours for intravenous (IV) tPA (tissue Plasminogen Activator). What isn’t being stressed is that IV tPA is only one possible answer with limited use. To receive IV tPA, patients must meet strict criteria and candidates are frequently excluded. There are new generations of thrombolytic drugs to open clogged vessels as well as neuroprotective agents under investigation. And in the hands of skilled neuro-interventionalists, some of the miniature mechanical tools that can be placed in arteries—snares, guidewires, catheters, stents, lasers, and neuro-jets— can stage miracle recoveries in minimally invasive procedures. Because of advanced—before, during and after—medical protocols, only a comprehensive stroke center offers real options of survival without disabilities. Paralysis, pain, cognitive, language and emotional deficits aren’t every stroke victim’s fate. Jeffrey Farkas, MD, assistant professor and chief of interventional neuro-radiology, worries that too often the standard ER approach to acute ischemic stroke is old medicine. Five years ago, the treatment for every stroke was IV tPA. However, “not
ILLUSTRATIONS BY SCOTT SNOW