Stroke/Neurocritical Care Team at the International Stroke Congress
CPMC’s Stroke/Neurocritical Care Team presents new research at the International Stroke Congress
February 13, 2014
Time is of the essence for treating acute ischemic stroke (AIS) and preventing permanent damage to the brain. The only FDA-approved treatment for ischemic strokes is tissue plasminogen activator (rt-PA/thrombolytic therapy), usually administered intravenously.
Pioneering research at California Pacific Medical Center determined that many criteria for thrombolytic therapy to treat AIS are unnecessarily complex. The S.M.A.R.T (Simplified Management of Acute Stroke using Revised Treatment Criteria) approach is a new method enabling physicians to quickly and efficiently determine which patients will benefit from thrombolytic treatment. This approach significantly reduces the number of barriers to administering thrombolytic therapy, while maintaining the safety and efficacy of treatment.
Nationally, fewer than 5% of patients with AIS receive lifesaving thrombolysis (clot-busting drugs), the most effective known treatment. At CPMC—home to one of the best stroke care and research programs in the U.S.—that rate averages over 25%, one of the highest rates nationwide.
Typically, the treatment window closes at around 4.5 hours post-stroke, but most people can’t get treatment in time. CPMC’s stroke team is conducting new research to find ways for administering treatments upwards of twelve hours, in part by using advanced imaging techniques that measure brain activity (which might suggest that thrombolysis will still help).
New research by CPMC’s stroke team will be presented at the American Heart Association’s International Stroke Congress in San Diego on Feb. 13. Results by Dr. Nobl Barazangi, Dr. David Tong, Sigrid Sorenson and their colleagues showed that expanding the use of the S.M.A.R.T approach to include outlying ‘spoke’ hospitals (including rural and community hospitals) in addition to comprehensive stroke care centers (such as CPMC) can increase treatment rates in AIS, with good neurologic outcome at discharge and low mortality rates.
In a retrospective study over four years of more than 500 AIS patients, results were comparable to those reported in randomized controlled trials, with low rates of intracranial hemorrhage (a complication of thrombolytic therapy).
“We believe this study shows that the S.M.A.R.T. criteria may be used broadly and not just at stroke centers, may help increase treatment for acute ischemic stroke nationally, and will hopefully encourage dialogue in the stroke community to revise the current t-PA criteria,” said Dr. Barazangi.