TAG: "Stroke"

Clot removal device improves outcomes for those with acute ischemic stroke


Treatment used in UCLA-led study could help 60,000 patients every year.

By Kim Irwin, UCLA

A new device to remove obstructing blood clots can significantly improve outcomes for people who suffer a certain type of stroke, according to a study led by a UCLA investigator.

In patients with acute ischemic stroke — in which a clot blocks the blood supply to part of the brain — who received a clot-busting drug, removing the obstructing blood clot with a stent retriever device significantly reduced post-stroke disability and increased the percentage of patients who were independent in daily function after three months.

The findings represent the first new treatment for acute ischemic stroke in 20 years, since the development of the clot-busting drug tPA, said Dr. Jeffrey Saver, the study’s global principal investigator and director of the UCLA Stroke Center.

“These findings are a paradigm shift — a new era in stroke care — and we are ecstatic,” said Saver, who is also a professor of neurology at the David Geffen School of Medicine at UCLA. “We will be able to treat many more patients, who will have much better outcomes. This is a once-in-a-generation advance in acute stroke care.”

The findings appear today (April 17) in the New England Journal of Medicine.

The study, called Solitaire With the Intention For Thrombectomy as PRIMary Endovascular Treatment (SWIFT PRIME), was conducted at 39 hospitals in the United States, Canada and Europe. The study enrolled 196 people. It was originally slated to enroll 833, but was halted early because of early positive results in this and other stent retrieval studies, Saver said.

The study tested a second-generation stent clot-retrieval device called Solitaire. The first-generation devices tested previously had shown no benefit over medical therapy alone, which Saver said was disappointing.

The new study tested the Solitaire on patients within six hours of the onset of stroke symptoms. The 196 patients were randomly assigned to be treated with either tPA alone or tPA along with stent retrieval of the clot, with 98 people in each group. Saver said the study showed the clot-removal devices outperformed tPA alone. Three months after having a stroke, 60 percent of the people who received clot retrieval as well as tPA were functionally independent and free from disability, compared to 35 percent of those who received tPA only.

For patients with a large clot, tPA only reopens vessels 25 to 30 percent of the time, Saver said. In the study, the stent retriever device opened the artery 88 percent of the time, even when there was a large clot.

The preclinical research used to help develop the Solitaire device was performed at UCLA by Dr. Reza Jahan, a professor of radiology at the David Geffen School of Medicine at UCLA and a member of the UCLA Stroke Center.

“This device reopened arteries much more frequently with less injury to the vessel,” said Jahan, who also served as global neurointerventional adviser for the trial.

“The Solitaire also caused less bleeding and was able to more easily engage and entangle clots.”

About 1 in 10 ischemic stroke patients can be taken to a catheter lab in time to perform the clot retrieval. This means that about 60,000 stroke patients a year could benefit from the two-pronged treatment approach.

“While this won’t help all stroke patients, the ones it will help have the most disabling strokes,” said Dr. Sidney Starkman, the UCLA study site principal investigator and co-director of the UCLA Stroke Center

“Right now, they get tPA and it helps a third of them, but the other two-thirds end up dependent on others for help or they die,” said Starkman, who is also professor of emergency medicine and neurology at the David Geffen School of Medicine at UCLA.

UCLA has a long history developing and testing stent retrieval devices, Saver said. The first clot retrieval stent device, a coil retriever, was invented at UCLA, and several major clinical trials of clot retrieval devices have been led by UCLA Stroke Center doctors.

“We are very happy to see this decade-long research program result in an important advance for stroke patients,” said Saver.

The study was one of three positive stent retrieval studies presented in February at the International Stroke Conference.

Stroke is the fifth leading cause of death in the United States and is a major cause of adult disability. About 800,000 people in the United States have a stroke each year. One American dies from a stroke every four minutes, on average.

The SWIFT PRIME trial was funded by Medtronic, which manufactures the Solitaire device.

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Artificial blood vessel lets researchers better assess clot removal devices


Novel technology could improve device design, improve post-stroke recovery.

By Scott LaFee, UC San Diego

Researchers at the UC San Diego School of Medicine have created an in vitro, live-cell artificial vessel that can be used to study both the application and effects of devices used to extract life-threatening blood clots in the brain. The artificial vessel could have significant implications for future development of endovascular technologies, including reducing the need for animal models to test new devices or approaches.

The findings are published in the current online issue of the journal Stroke.

Cerebrovascular disease covers a group of dysfunctions related to blood vessels supplying the brain. Risk factors include hypertension, diabetes, smoking and ischemic heart disease. More than 6 million American adults are affected, with the number steadily growing.

When blood supply to the brain is significantly diminished or blocked, an acute stroke may result, requiring quick medical intervention to avoid permanent brain damage or death. More than 795,000 Americans experience a stroke each year; 130,000 die.

“Timely restoration of normal blood flow is absolutely critical,” said Alexander Khalessi, M.D., director of endovascular neurosurgery and surgical director of neurocritical care at UC San Diego Health System. “Clot-dissolving drugs like tPA (tissue plasminogen activator) help, but might not work sufficiently fast or fully in some situations. In those cases, doctors must perform endovascular thrombectomies where they mechanically remove the emboli or clots.”

The rate of endovascular thrombectomies is rising, but the approach, which typically involves running a catheter to the site of the blockage and using one of several marketed devices to remove the clot, can be improved, said Khalessi. For example, some patients experience negative consequences caused by either the mechanical removal of the emboli or by the restoration of blood flow, called reperfusion, specifically to the endothelial cells (ECs) that form the lining of blood vessels.

Current pre-clinical analyses of new therapeutic approaches or devices is limited to either in vitro glass or plastic tubing testing intended to mimic biological counterparts or by using animal models, such as pigs.

“Both of these have significant drawbacks. Although transparent and thus easier to study, glass and plastic tubing does not recapitulate blood vessel biology,” said Khalessi. “In vivo animal models are more realistic, but we cannot directly observe the interaction between devices and ECs. Plus animals are not perfect models of humans and they are expensive to use.”

Khalessi, along with co-author Shu Chien, M.D., Ph.D., director of UC San Diego’s Institute of Engineering in Medicine, and colleagues developed a novel in vitro live-cell platform that allows direct visual characterization of effects and injury patterns to ECs. Bovine artery ECs were perfused into optically clear, biocompatible tubular silicone with a thickness of 0.25 millimeters and inner diameters of 2.5, 3.5 and 4.5 millimeters.

The researchers then introduced porcine blood clots into the platform, allowing the clots to integrate, tested various clot-retrieval devices and examined the post-removal effects.

“We found that the in vitro platform permitted high-resolution quantification and characterization of the pattern and timing of EC injury with various thrombectomy devices and vessel diameters. The devices each displayed different effects.”

The researchers subsequently validated their in vitro findings with in vivo testing.

“This work offers significant promise going forward,” said Khalessi. “The live-cell artificial vessel enabled us to conduct detailed studies of the endothelium after thrombectomy, which may contribute to future device design. Animal studies confirmed the relevance of the platform, which suggests the artificial model could represent a practical, scalable and physiological alternative to existing technologies.”

Co-authors include Dayu Teng, Jieying Li, and Yi-Shuan Li, UCSD Department of Bioengineering and Institute of Engineering in Medicine; and Jeffrey Scott Pannell, Robert C. Rennert, and Victor W. Wong, UCSD Division of Neurosurgery.

Funding for this research came, in part, from competitive grants from Covidien Ltd. and Penumbra Inc.

Disclosure: Alexander Khalessi holds consulting arrangements for physician training with Stryker Neurovascular, Covidien and Penumbra.

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1 in 4 atrial fibrillation patients receives unnecessary blood thinners


Researchers believe cardiology specialists may be unaware of risk.

An electrocardiogram reading traces irregular, rapid and chaotic atrial activity, seen in lead V1 (the top squiggly line).

By Heather Buschman, UC San Diego

About one quarter of all atrial fibrillation patients at the lowest risk for stroke receive unnecessary blood thinners from cardiology specialists, according to a new study by researchers at the UC San Diego School of Medicine and UC San Francisco, and these health care providers must be made aware of the resulting potential health risks. The findings are published online today (April 13) by JAMA Internal Medicine.

“Clinicians who prescribe blood thinners need to be diligent about weighing the risks and benefits of these medications,” said lead author Jonathan C. Hsu, M.D., cardiologist and assistant clinical professor of medicine at UC San Diego. “In those who have no risk factors for stroke, the risk of bleeding likely outweighs the benefit of stroke reduction. The fact that blood thinners were prescribed to so many patients with no risk factors for stroke is a wakeup call that we need to do better for our patients.”

In atrial fibrillation, electrical impulses are triggered from many areas in and around the upper chambers of the heart instead of just one area. This activity is chaotic, and the atrial walls quiver rather than contract normally in moving blood to the lower chambers.

For atrial fibrillation patients at risk for blood clots, anticoagulation therapies such as warfarin or other drugs reduce the risk of illness and death. But because their use carries a bleeding risk, they are not recommended for atrial fibrillation patients at a particularly low risk for stroke.

In fact, current guidelines do not recommend oral anticoagulation in patients under age 60 without heart disease or other known risk factors for blood clots or in atrial fibrillation patients without any established risk factor for stroke. What’s more, the previous guidelines, which were in place at the time the data for this study were collected, contained a very strong recommendation specifically to avoid anticoagulants in that population.

To examine the prevalence of inappropriate anticoagulant prescriptions in young and healthy patients at the lowest risk for blood clots, Hsu and team used a large national registry of cardiovascular patients. From this, they reviewed nearly 11,000 patients age 60 and under and found that roughly 25 percent were prescribed oral anticoagulant therapy contrary to contemporary guideline recommendations. Further, they found that males with atrial fibrillation at the lowest risk of stroke were more likely to be prescribed oral anticoagulation than females, as were older patients and overweight patients without stroke risk factors.

“The irony is that there is a general push to get providers to prescribe these drugs, and they are also generally under-prescribed among many atrial fibrillation patients who actually need them,” said senior author Gregory Marcus, M.D., director of clinical research at UC San Francisco. “Our study suggests people are trying to do the right thing but, due to a lack of understanding of some of the critical nuances, go too far in that direction in low-risk patients.”

Co-authors of this study also include Paul S. Chan, Fengming Tang, St. Luke’s Mid America Heart Institute and the University of Missouri, Kansas City; and Thomas M. Maddox, Veterans Affairs Eastern Colorado Health Care System/University of Colorado School of Medicine.

This research was funded, in part, by the National Heart, Lung and Blood Institute, part of the National Institutes of Health, (grant K23HL102224), U.S. Department of Veterans Affairs, Medtronic and SentreHeart Inc.

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Heart pouch may explain potentially important cause of strokes


UC Irvine findings could lead to new therapeutic strategies for preventing stroke.

By Tom Vasich, UC Irvine

A pouchlike structure inside the heart’s left atrial chamber in some people may explain strokes that otherwise lack an identifiable cause, according to UC Irvine School of Medicine researchers.

Dr. Mark Fisher, a professor of neurology and pathology & laboratory medicine, and colleagues evaluated 75 stroke patients at UC Irvine Medical Center to learn whether this left atrial septal pouch could be a potent source of stroke-causing blood clots.

Of the 23 patients who had experienced a stroke of undetermined origin (a “cryptogenic” stroke), 30 percent possessed the left atrial septal pouch. It was present in only 10 percent of the 52 patients who’d had a stroke with an identifiable trigger.

Stroke is the leading cause of long-term severe disability and the fourth-most-common cause of death in the U.S. About 80 percent of the 700,000-plus strokes that occur annually in this country are due to blood clots blocking a brain artery. In up to a third of these cases, the clots’ origin cannot be determined.

UC Irvine cardiologists first discovered this pouchlike structure inside the heart’s left atrial chamber in a 2010 study.

“The cul-de-sac nature of this heart pouch may promote stagnation of the blood, forming clots that can travel into the brain and cause a stroke,” Fisher said.

“This finding points to a potentially important cause of strokes,” he added. “The presence of this pouch could change how neurologists treat these patients and lead to new therapeutic strategies for preventing strokes.”

Fisher said that large-scale studies are necessary to verify the results of this study, which appears online in Frontiers in Neurology at http://journal.frontiersin.org/article/10.3389/fneur.2015.00057/abstract.

The research was conducted at UC Irvine Medical Center by members of the Department of Neurology (Fisher and Dr. Annlia Paganini-Hill), the Division of Cardiology (Drs. Dawn Lombardo, Nathan Wong, Ailin Barseghian, Jashdeep Dhoot, Harkawal Hundal and Jonathan Salcedo) and the UCI School of Medicine (Dr. Jonathan Wong, who is now with the California Pacific Medical Center). It was supported by the American Heart Association.

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Brain’s iconic seat of speech goes silent when we actually talk


UC Berkeley discovery has implications for diagnoses, treatments of stroke, epilepsy.

New findings will better help map out the brain’s speech regions (Photo courtesy of Adeen Flinker)

By Yasmin Anwar, UC Berkeley

For 150 years, the iconic Broca’s area of the brain has been recognized as the command center for human speech, including vocalization. Now, scientists at UC Berkeley and Johns Hopkins University in Maryland are challenging this long-held assumption with new evidence that Broca’s area actually switches off when we talk out loud.

The findings, reported today (Feb. 16) in the Proceedings of the National Academy of Sciences journal, provide a more complex picture than previously thought of the frontal brain regions involved in speech production. The discovery has major implications for the diagnoses and treatments of stroke, epilepsy and brain injuries that result in language impairments.

“Every year millions of people suffer from stroke, some of which can lead to severe impairments in perceiving and producing language when critical brain areas are damaged,” said study lead author Adeen Flinker, a postdoctoral researcher at New York University who conducted the study as a UC Berkeley Ph.D. student. “Our results could help us advance language mapping during neurosurgery as well as the assessment of language impairments.”

Flinker said that neuroscientists traditionally organized the brain’s language center into two main regions: one for perceiving speech and one for producing speech.

“That belief drives how we map out language during neurosurgery and classify language impairments,” he said. “This new finding helps us move towards a less dichotomous view where Broca’s area is not a center for speech production, but rather a critical area for integrating and coordinating information across other brain regions.”

In the 1860s, French physician Pierre Paul Broca pinpointed this prefrontal brain region as the seat of speech. Broca’s area has since ranked among the brain’s most closely examined language regions in cognitive psychology. People with Broca’s aphasia are characterized as having suffered damage to the brain’s frontal lobe and tend to speak in short, stilted phrases that often omit short connecting words such as “the” and “and.”

Specifically, Flinker and fellow researchers have found that Broca’s area — which is located in the frontal cortex above and behind the left eye — engages with the brain’s temporal cortex, which organizes sensory input, and later the motor cortex, as we process language and plan which sounds and movements of the mouth to use, and in what order. However, the study found, it disengages when we actually start to utter word sequences.

“Broca’s area shuts down during the actual delivery of speech, but it may remain active during conversation as part of planning future words and full sentences,” Flinker said.

The study tracked electrical signals emitted from the brains of seven hospitalized epilepsy patients as they repeated spoken and written words aloud. Researchers followed that brain activity – using event-related causality technology – from the auditory cortex, where the patients processed the words they heard, to Broca’s area, where they prepared to articulate the words to repeat, to the motor cortex, where they finally spoke the words out loud.

In addition to Flinker, other co-authors and researchers on the study are Robert Knight and Avgusta Shestyuk at the Helen Wills Neuroscience Institute at UC Berkeley, Nina Dronkers at the Center for Aphasia and Related Disorders at the Veterans Affairs Northern California Health Care System, and Anna Korzeniewska, Piotr Franaszczuk and Nathan Crone at Johns Hopkins School of Medicine.

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Paramedics may be best first lineof defense in treating stroke patients


First-of-its-kind study, led by UCLA, offers hope for faster, more effective care.

By Kim Irwin, UCLA

A consortium led by UCLA physicians has found that paramedics can safely start providing people with medication in the first minutes after the onset of a stroke instead of waiting for them to receive treatment at a hospital.

Although the drug tested, magnesium sulfate, did not improve patient outcomes, the research points to a new method for treating stroke patients quickly.

For people who have suffered a stroke, immediate treatment is key — the more time that passes before the restoration of blood flow, the higher the likelihood that stroke victims will suffer irreversible brain damage.

The study findings indicate that paramedics can give intravenous medications to stroke patients within the “golden hour,” the window during which treatments are most likely to help patients survive and avoid debilitating, long-term neurological damage. That finding is a game-changer, said Dr. Jeffrey Saver, the study’s co-principal investigator and director of the UCLA Stroke Center.

“The trial succeeded in its goal of devising a means to deliver promising drugs to stroke patients in the first minutes, when there’s the greatest amount of brain to save. We have opened a new therapeutic window that is now being used to test other compounds and deliver clot-busting drugs to patients in the field,” said Saver, who also is a professor of neurology at the David Geffen School of Medicine at UCLA. “Stroke is a true emergency condition. Time lost is brain lost — for every minute that goes by without restoration of blood flow, 2 million nerve cells are lost.”

The study appears in today’s (Feb. 5) issue of the New England Journal of Medicine.

The phase 3 Field Administration of Stroke Therapy–Magnesium (FAST–MAG) clinical trial involved collaboration among 315 ambulances, 40 emergency medical service agencies, 60 receiving hospitals, 715 emergency physicians, 210 neurologists, 26 neurosurgeons and 2,988 paramedics in Los Angeles and Orange counties. In the study, half of the 1,700 patients had the study drug administered within 45 minutes, while 74 percent were treated within the golden hour.

“This study involved an unprecedented cooperative effort of paramedics in the field and emergency physicians serving as investigators,” said Dr. Sidney Starkman, co-principal investigator and co-director of the UCLA Stroke Center.

“Through this study we were able to instill permanently in everyone’s mind the idea that ‘time is brain.’ We believe this represents a paradigm shift in the treatment of stroke and potentially numerous other neurological conditions,” said Starkman, who also is professor of emergency medicine and neurology at the Geffen School. “We demonstrated that paramedics not only are eager to provide the best possible patient care, but also are capable of being invaluable partners in an intense, time-dependent clinical trial.”

Today, the only ways to treat strokes caused by blocked blood vessels are to reopen the arteries with tissue plasminogen activator, a clot-busting drug, or to use catheters to remove the clot. But, in general, neither can be done until the patient arrives at the hospital and undergoes a CT scan to rule out bleeding in the brain. Additional treatments can only be offered after that, by which time substantial brain injury may already have occurred.

The FAST–MAG trial used magnesium because in animal studies it dilated blood vessels and increased blood flow in the brain. Magnesium also countered the damaging calcium buildup that occurs when cells are deprived of oxygen. It had been already approved for use in humans, it had a good safety profile and paramedics were familiar with it.

“Now we are tasked with finding a different agent or combination of agents that can improve stroke outcomes within that golden hour,” Saver said. “The ambulance treatment platform can be used around the world to test promising agents.”

Dr. Bill Koenig, medical director of the Los Angeles County Emergency Medical Service Agency, worked closely with Saver and Starkman on the FAST-MAG study.

“To assist paramedic recognition of stroke victims, the nationally recognized Los Angeles Pre-hospital Stroke Screen was developed,” Koenig said. “FAST-MAG also served as an impetus to create the Los Angeles County System of Stroke Hospitals, which every year treats over 10,000 stroke victims. When the day comes that a medication can successfully treat stroke in its early stages, this novel system in Los Angeles will be well positioned to immediately apply the treatment to our patients. I am confident that with the dedicated investigators, along with a finely tuned EMS system, that discovery will be sooner rather than later.”

Dr. Walter Koroshetz, acting director of the National Institute of Neurological Disorders and Stroke, said this study shows that it is possible to get treatments to stroke patients even before they arrive at a hospital.

“Because a blocked blood vessel causes brain damage over minutes to hours, this pre-hospital approach to treatment is sure to be adopted and refined in clinical research studies,” Koroshetz said. “Ultra-early brain salvage in stroke patients will someday surely reduce the tremendous burden of disability and death due to stroke.”

Saver said clinical trials currently being conducted in the U.S., Canada and England are testing new compounds using the early treatment infrastructure created by the FAST–MAG study.

Stroke is the fifth leading cause of death in the U.S. and is a major cause of adult disability. About 800,000 people in the U.S. have strokes each year, and one person dies from a stroke every four minutes, on average.

The study was funded by the National Institute of Neurological Disorders and Stroke at the National Institutes of Health.

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UC San Diego to host region’s first camp for stroke survivors, caregivers


Therapeutic retreat offers support, education and a bit of fun.

Alexander Khalessi, UC San Diego

By Jackie Carr, UC San Diego

On Jan. 23-25, more than 15 stroke survivors and their caregivers will go on a mini-vacation in La Jolla as part of a therapeutic retreat for those whose lives have been affected – sometimes turned upside down – by stroke. The 50s-themed stroke camp is being co-hosted by UC San Diego Health System, which has one of the nation’s first certified Comprehensive Stroke Centers.

“Stroke camp is part of UC San Diego’s larger commitment to the care of neurovascular patients and their families,” said Alexander Khalessi, M.D., director of endovascular neurosurgery and surgical director of neurocritical care at UC San Diego Health System. “Beyond receiving the best possible neurological care or developing new therapies, we support patients through their recovery and get them back to their lives.”

The camp will be the first Refresh & Retreat Stroke Camp in California, with the flare of an American Bandstand theme, complete with an invitation to bring “your letter sweaters, poodle skirts and dancing shoes.” The event is sponsored with Covidien, a global health care leader.

Stroke care has advanced rapidly in recent years, but strokes still involve some permanent loss of healthy brain tissue due to either a lack of blood flow or bleeding within the brain itself. As a result, many stroke survivors require significant time to recover and rehabilitate. During this healing process, it is the caregivers – often a spouse or family member – who may suddenly find themselves overwhelmed and socially isolated by their new responsibilities.

“Stroke camp is about pampering the caregivers and recognizing the toll strokes take on them,” said Julie Jurf, R.N., stroke care coordinator, UC San Diego Health System. “The camp’s aim is to bring fun, respite and renewal to stroke survivors, their families and caregivers.”

Jurf will volunteer at the retreat to assist caregivers.

“I will be pushing a wheelchair, standing in line for food, or doing whatever needs to be done so that my caregiver can go for a swim or relax,” she said. “Even just a two-day break can go a long way to bring renewal to people’s life.”

Khalessi added that stroke camp provides patients with support and encouragement, offers a welcome rest for their caregivers, and provides an opportunity to bond with other stroke survivors.

Over three days, attendees will be invited to participate in a variety of camp-like activities, including drum circles, craft-time and 50’s bingo, as well as survivor and caregiver break-out discussion sessions that allow attendees to vent, share and console as needed.

In addition, Khalessi, a national expert in catheter-based and open cranial neurosurgeries for stroke, aneurysms and other blood vessel disorders of the brain, will lead a tour of the Center for the Future of Surgery at the UC San Diego School of Medicine. This facility is a national destination for developing and refining new life-saving stroke treatments, now transforming the standard of care for stroke patients.

“Stroke is a disease that had no solutions 30 years ago. It is now a treatable medical and neurosurgical emergency. Even five years ago, stroke care involved a single drug and supporting patients through their new disabilities,” Khalessi said. “We now have catheter-based procedures and devices that allow for rapid and safe restoration of blood flow in the most severe forms of stroke, involving large vessels of the brain,” a procedure known as stent thrombectomy that in a recent study published in the New England Journal of Medicine greatly improved stroke patients’ prognoses.

“We have phenomenal new treatments for hemorrhagic stroke, or bleeds within the brain, due to cerebral aneurysms or high blood pressure, using minimally invasive surgical or catheter-based techniques,” he said. “These strokes are no less devastating and were a death sentence a decade ago.”

The designation of a Comprehensive Stroke Center at UC San Diego Health System is formal recognition of its ability to receive and treat the most complex stroke cases around the clock, every day of the year, with a multidisciplinary team of neurologists, neurosurgeons, cardiologists and rehabilitation specialists.

Approximately 680,000 American’s each year survive a stroke, making stroke the nation’s leading cause of disability. A patient’s ability to benefit from the latest in stroke-care technologies hinges upon a third party recognizing stroke and ensuring that the patient is brought to a hospital where comprehensive stroke care can be provided.

About Retreat & Refresh Stroke Camp
Retreat & Refresh Stroke Camp is a nonprofit based in Peoria, Illinois. It has sponsored 105 stroke camps nationwide since 2004. The nonprofit’s founder and executive director, Marylee Nunley, is caregiver to her husband John, who had a stroke in 2001. For more information, visit http://strokecamp.org.

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UCLA honored for stroke care


Receives Get With The Guidelines award for implementing quality improvement measures.

The UCLA Comprehensive Stroke Center at Ronald Reagan UCLA Medical Center has received a Get With The Guidelines – Stroke award for implementing specific quality improvement measures outlined by the American Heart Association/American Stroke Association for the treatment of stroke patients.

Get With The Guidelines – Stroke helps hospital teams provide the most up-to-date, research-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. UCLA earned the Gold-Plus Quality Achievement Award award for measures that include aggressive use of medications and risk-reduction therapies aimed at reducing death and disability and improving the lives of stroke patients.

UCLA also received the association’s Target: Stroke Honor Roll for meeting stroke quality measures that reduce the time between hospital arrival and treatment with the clot-buster tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. People who suffer a stroke who receive the drug within three hours of the onset of symptoms may recover quicker and are less likely to suffer severe disability.

“At the UCLA Comprehensive Stroke Center, we are dedicated to improving the quality of stroke care, and The American Heart Association/American Stroke Association’s Get With The Guidelines–Stroke helps us achieve that goal,” said Dr. Jeffrey Saver, director of the UCLA Stroke Center and professor of neurology at the David Geffen School of Medicine at UCLA. “With this award, our hospital demonstrates our commitment to ensure that our patients receive care based on internationally-respected clinical guidelines.”

“We are pleased to recognize UCLA for their commitment and dedication to stroke care,” said Dr. Deepak L. Bhatt, national chairman of the Get With The Guidelines steering committee and executive director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School. “Studies have shown that hospitals that consistently follow Get With The Guidelines quality improvement measures can reduce patients’ length of stays and 30-day readmission rates and reduce disparity gaps in care.”

Get With The Guidelines–Stroke also helps UCLA’s staff implement prevention measures, which include educating stroke patients to manage their risk factors and to be aware of warning signs for stroke, and ensuring they take their medications properly. Hospitals can make customized patient education materials available upon discharge, based on the patients’ individual risk profiles. The take-away materials are written in an easy-to-understand format in either English or Spanish.

According to the American Heart Association/American Stroke Association, stroke is the number four cause of death and a leading cause of adult disability in the United States. On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

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Young adults not too young to be at risk for stroke


Knowing symptoms and getting immediate attention is crucial.

Jennifer Reilly was 28 years old when she began experiencing some odd symptoms. Half of her left hand went numb. She could move her fingers, but she couldn’t feel anything on the outer part of that hand.

Because she was so young, Reilly assumed it was nothing. She was wrong.

She was having a stroke.

The numbness recurred off and on for several days. Then one night she had a piercing headache, an uncommon event for her. She mentioned her symptoms to a work colleague, who urged her to see a doctor.

“I didn’t know I was having a stroke at the time,” said Reilly, now 35. “I just assumed I was a healthy, normal 28-year-old.”

Reilly saw several doctors and finally landed at UCLA in the neurology department, where she saw Dr. David Liebeskind, professor of neurology and director of outpatient stroke and neurovascular programs. After a battery of tests, Reilly was diagnosed with Moyamoya disease — a rare, progressive cerebrovascular disorder caused by blocked arteries at the base of the brain, which cuts off blood flow. One of the first symptoms of Moyamoya is recurrent transient ischemic attacks, or TIAs, commonly referred to as “mini-strokes,” which are exactly what Reilly was experiencing.

She had no idea the danger she was in, said Liebeskind, who is also director of the neurovascular imaging research core at UCLA.

“The worst and a very likely possibility is that she would have had a significant stroke,” he said, one that could have been extremely debilitating or even fatal.

Reilly was referred to Dr. Neil Martin, chair of neurosurgery at Ronald Reagan UCLA Medical Center and head of the neurovascular surgery section.

“He told me I needed to be admitted into the hospital immediately, and that I would be in surgery within 24 hours,” she said. “It was such a shock. I can’t fathom what my parents must have been going through. We had a few tears, and they stayed very strong for me.”

Dr. Nestor Gonzalez, an associate professor of neurosurgery and radiology, performed two nine-hour brain surgeries on Reilly to reroute arteries that normally bring blood to the scalp to instead supply blood to her brain. Over time, the arteries formed new branches and restored blood supply to the brain.

Gonzalez highlighted the importance of Reilly acting quickly after her symptoms began.

“The good thing is that she sought attention when she started having those symptoms and we were able to diagnose her condition very early,” he said. “We were able to avert a stroke that could have devastated her life.”

It’s a common misconception that strokes only affect older people, Gonzalez said.

“A stroke is not a disease limited to elder individuals,” he said. “It is a condition that can affect younger individuals, even kids. The moment someone feels any of the symptoms of a stroke, they need to seek immediate emergency attention.”

Liebeskind said the most common signs of stroke include sudden onset of weakness, sudden onset of numbness, difficulty speaking, difficulty seeing and difficulty interacting with other individuals.

It’s been nearly six years since her mini strokes and surgeries and today Reilly is embracing life. She got married and will celebrate her third wedding anniversary next June.

“Since my recovery I have an absolutely newfound perspective on life,” she said. “I really try to stop and appreciate that I was given a second chance.”

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Researchers find promising new treatment approach for ischemic stroke


‘Sonic hedgehog’ plays key role in reducing size of stroke, promoting nerve regeneration.

(From left) Peter Bannerman, Olga Chechneva and Wenbin Deng, UC Davis

A team of UC Davis scientists has found that administering a small molecule – purmorphamine – in animal models after a stroke results in multiple protective effects, including reducing the size of the stroke, decreasing inflammation and increasing markers for nerve regeneration. The findings, which may offer a new approach to treating ischemic stroke — the disruption of blood flow in the brain from a blood clot — are published online in the journal Cell Death and Disease.

“We have revealed a previously unrecognized role of a developmental pathway that, when stimulated with a small molecule drug, leads to neuroprotection, regeneration and functional recovery following ischemic stroke,” said Wenbin Deng, associate professor in the UC Davis Department of Biochemistry and Molecular Medicine, and principal investigator of the study. “This is an important conceptual advance that could lead to a novel treatment approach, paving the way for new medicines in the treatment of a variety of neurological and neurodegenerative diseases.”

Deng added that the neuroprotective small molecule compound has broad in vitro and in vivo activities and offers new opportunities for studying neurological diseases and injuries as well as developmental and degenerative diseases in other tissues sharing common mechanisms. He and his research team focused on the humorously named “sonic hedgehog” signaling pathway, which plays a fundamental role in the early development of the central nervous system, regulating the generation and survival of neurons and other brain cells. It is also activated in response to an injury to the nervous system and has been shown to have beneficial effects in animal models of various conditions including stroke, multiple sclerosis and amyotrophic lateral sclerosis (ALS).

A key component of the sonic hedgehog pathway is the so-called Smoothened protein, a receptor that when stimulated promotes activation of the pathway. Purmorphamine is a small molecule that was developed to be a stimulator (also called an agonist) of the Smoothened protein.

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Colds may temporarily increase stroke risk in kids


Study shows colds, flu can create short-lived increased stroke risk in vulnerable children.

A new study suggests that colds and other minor infections may temporarily increase stroke risk in children. The study found that the risk of stroke was increased only within a three-day period between a child’s visit to the doctor for signs of infection and having the stroke.

The study was led by researchers at UCSF Benioff Children’s Hospital San Francisco in collaboration with the Kaiser Permanente Division of Research.

“These findings suggest that infection has a powerful but short-lived effect on stroke risk,” said senior author Heather Fullerton, M.D., a pediatric vascular neurologist and medical director of the Pediatric Brain Center at UCSF Benioff Children’s Hospital San Francisco.

“We’ve seen this increase in stroke risk from infection in adults, but until now, an association has not been studied in children.”

Strokes are extremely rare in children, affecting just 5 out of 100,000 kids per year. “The infections are acting as a trigger in children who are likely predisposed to stroke,” said Fullerton. “Infection prevention is key for kids who are at risk for stroke, and we should make sure those kids are getting vaccinated against whatever infections – such as flu – that they can.”

The study appears in today’s (Aug. 20) online issue of Neurology.

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Coalition teams to help reduce heart attacks, strokes in San Diego County


UC San Diego part of regional project awarded $5.8M Health Care Innovation grant.

Approximately 84 million people in the United States suffer from some form of cardiovascular disease, and about 720,000 Americans have a heart attack every year, which works out to one every 44 seconds. To address these alarming statistics, the Be There San Diego Initiative has been awarded a $5.8 million Health Care Innovation grant for a coalition project to help reduce heart attacks and strokes in San Diego County.

The initiative’s program, San Diego: A Heart Attack and Stroke Free Zone, is a regional collaboration of health care organizations and stakeholders to improve health care delivery and patient outcomes.

The goal during the three year project is to enroll 4,000 high-risk patients and lower their blood pressure and cholesterol levels through evidence-based practices and a better understanding of the importance of treatment adherence. The project will also promote heart attack and stroke prevention measures, test novel, cost-effective technology solutions and provide educational opportunities both for patients and within the physician community.

Partners in the Be There Initiative include UC San Diego Health System, Arch Health Partners, Scripps Health, Sharp HealthCare, Kaiser Permanente, Palomar Medical Center, Naval Medical Center, Veterans Administration, the San Diego County Medical Society Foundation, the County of San Diego Health and Human Services Agency, community clinics and others. UC San Diego Health System serves as the fiscal agent for the project.

“Health organizations that are competitive in the market will be working together for the benefit of San Diego patients,” said Anthony DeMaria, M.D., principal investigator of the Heart Attack and Stroke Free Zone program and cardiologist at UC San Diego Health System. “This approach will decrease our community’s risk for cardiovascular disease and could result in saving millions in the county by preventing half of the heart attacks and strokes that would have otherwise occurred in the participating patient population.”

Patients will be educated about the program, consented and enrolled through their physician’s office beginning later this year. Participants will also receive blood pressure cuffs to monitor levels at home and work closely with a health care coach.

“Because it’s a silent condition, we find that many patients are unaware of having hypertension, and only about 40 percent of patients diagnosed with high blood pressure take their medication, which can directly lead to cardiovascular disease. We hope through the Heart Attack and Stroke Free Zone program, we can increase this to 80 percent,” said Katherine Bailey, executive director of the Be There Initiative.

The Health Care Innovation grant supporting the project is made possible by the Centers for Medicare and Medicaid Services (CMS) through the Affordable Care Act and is part of an ongoing effort to advance innovative solutions in delivering and improving patient care across the nation.

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