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Recently, the New England Journal of Medicine

announced research expanding the treatment of stroke.
Harold Adams, MD, director of the Division of
Cerebrovascular Disorders at University of Iowa Hospitals
and Clinics, talks about this expanded therapy and stroke
treatment in general

 


The term stroke describes a number of blood vessel

diseases of the brain, the most common of which are due
to a blood clot closing off an artery supplying part of the
brain. In many ways a stroke is to the brain like a heart KXIC broadcasts
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The symptoms of stroke reflect the area of the brain that
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Harold Adams, MD
Strokes can occur in anybody of any age. Stroke can
occur in children, can occur in young adults, and most
commonly occurs in people over the age of 60. Age is an
important risk factor. People who have heart disease,
people who have diabetes, people who have high blood
pressure or high cholesterol are also at an increased risk
of stroke, as are those people who smoke.




  



The goal of modern stroke treatment is to try to limit the

brain injury, and time truly is crucial. We have therapies
that prove invaluable including the clot busting drug t-PA
that was in the article in the New England Journal of
Medicine.

What we have found is that time is very, very important,

so the earlier we can treat people, the better chance we
have for success. While the article in the New England
Journal of Medicine describes that we now may be able to
treat people²four and one-half hours after onset of
stroke²successfully with these clot busting drugs. The
key message still is going to be to try to treat them
earlier, because if we can restore blood supply to the
brain, we have the opportunity to limit the amount of
brain injury.


  

  

 

This will hopefully allow more people to be treated. At

present time²or up until this publication²our time
window was three hours, but now we are going to be
able to move this to four and one-half hours, which
hopefully will allow more people to be treated.

However, we want to avoid delaying treatment, so the

goal will still be to get to the hospital as quickly as
possible, because we have much better chance for
success if we can treat somebody within two hours, for
example, rather than within four and one-half.

    
   





  

Rescue therapy is something that we offer at The

University of Iowa. This is not available at many other
institutions because it involves an integrated approach
where we are trying other interventions in patients who
may not be able to be treated with the intravenous tPA,
or who are treated with intravenous tPA and may not
improve. This involves endovascular procedures where
our colleagues in the Department of Radiology place a
catheter in an artery to the brain and try to reopen the
artery or remove the clot.

  
   


This will hopefully expand the number of people who may

be able to be treated by the time window. Now, we¶ve
been able to move from three to four and one-half hours,
now that¶s an important advance, but there still may be
other people we could treat with these other
interventions, maybe out to six to eight hours. The
chances for success are not as well established. This is
not as established therapy as IV tPA, and IV tPA remains
the most important treatment.


   

    


 
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The chances are quite good. In some of the studies that

have been done, we found that if we can treat two
people within 90 minutes, one of those two people likely
will have almost complete recovery. So that¶s a 50
percent success rate, which is really very good when
we¶re talking about severe diseases of the brain. As we
move out longer from the time of stroke, the chances of
success drop, and that¶s why the message µtime is brain¶
is such an important component of our goals of early
treatment.