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Latest Research Findings in Treating Stroke
By Dr. Helmi Lutsep
Stents—A Few millimeters of Rrevention
While we’ve known for a long time that stroke can be caused by the narrowing of the carotid arteries, we now know that the risk of stroke can be just as high from narrowing of the blood vessels inside the head.
These blood vessels are smaller than the carotid vessels, so we’ve needed to develop different surgery techniques. Angioplasty with stenting is one technique that has shown a lot of promise. Using stents – tiny mesh sleeves only a few millimeters in size – we’re able to prop open the vessels.
The studies using stents have been going on for a number of years and we’re now in the process of using randomized trials, comparing stents to medical therapy such as aspirin and risk factor modifications.
More Treatment Options, More Precious Time
For the past 13 years, the most common treatment for ischemic stroke has been t-PA, a clot-dissolving drug given through the vein. There is a small window of time – usually only three hours from the onset of stroke – to administer this medication. And while we’ve had a lot of success with t-PA, it doesn’t work for everyone. Now we are beginning to use other methods for the strokes that affect the largest blood vessels inside the head. An interventionist places a catheter up to the brain and can now remove the clot by either using a tiny cork-screw like devise that pulls it out or an aspirator that suctions out the blood clot.
One of the advantages of this catheter treatment is that it allows us a bigger window of time – up to eight hours versus the three hours we have to administer t-PA. This gives people a second chance if the three hours have already passed, or if the t-PA wasn’t successful.
OHSU Plays a Critical Role in These Breakthroughs
I’m proud to say that Oregon Health & Science University has been instrumental in the trials that have studied carotid disease and the use of stents in treating narrowed vessels. We have developed some of the protocols using stents to treat the tiny vessels deep inside the brain. OHSU has also led much of the work in using the catheter methods for removing the clot by pulling or suctioning it out of the brain.
Dr. Helmi Lutsep serves as the associate director of the Oregon Stroke Center. She received her medical degree from Mayo Medical School in 1988, and completed her residency at the Mayo Graduate School of Medicine, as well as her cerebrovascular disease fellowship at Stanford University. Dr. Lutsep’s clinical area of focus is stroke prevention and acute stroke treatment.
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