What's the next phase of stroke treatment?

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I was fortunate enough to be in the right place, right time in 1998 - just two years after approval of clot-buster tissue plasminogen activator, also known as tPA or alteplase.

However, it's true that little has changed since then. Researchers have looked at different windows of time for the drug, which can quickly dissolve a clot to prevent further stroke damage, but new, safer and more effective drugs have not come to pass.

I have little right to complain about tPA, but I'm just one guy who benefited. It has its dangers, too. And while there are some good signs related to using devices to remove clots, much more research and work are needed to improve treatment and stroke outcomes.

You can read a recent article summarizing the need for the next phase in stroke treatment:

Another study shows possible stroke treatment outcomes

As the year gets close to an end, we've lately seen two pieces of news that might - might - lead to better outcomes for stroke patients in hospitals.

A few days ago, there was research showing that a clot removal technique might be the next step in certain stroke treatment. Click here to read about it.

One of the concerns about tissue plasminogen activator clotbuster - tPA - is a risk of bleeding. Now, though, research indicates the possibility that another drug might counters tPA risks:

Positive news for new stroke treatment - clot removal

There's promising news that there's more than one way to battle a clot-related stroke. Maybe, in some circumstances, better than current medical treatment.

Read here about a study showing how clot removal proves mettle in large-vessel strokes:

Health risks can linger long after a stroke

After a stroke, after leaving the hospital, after a few months, memories fade and, human nature being human nature, people tend to relax their guards.

However, a few months might not long enough to assure health risks are adequately addressed after a stroke. A recent study indicates health risks after a stroke may linger for at least five years:

In the study, Swartz's team analyzed data from about 24,000 patients in Canada who suffered a stroke or mini-stroke, clinically known as a "transient ischemic attack" (TIA).

All of the patients had already survived the "high-danger" period, which is typically thought to be the 90 days after hospital discharge.

However, within the first year after this high-risk period, 9.3 percent of the patients died, had a repeat stroke, mini-stroke, heart attack or were admitted to long-term care. Death was the most common of these events, affecting more than 5 percent of patients in the first year.

Among patients who were still alive after a year, the rate of these events remained at 5 percent in each of the following four years, according to the study to be presented Tuesday at the Canadian Stroke Congress in Vancouver.

"We now need to identify ways to determine which people, among those who have made it through the riskiest period, remain most at risk for serious events so we can develop appropriate preventive interventions," Swartz said.

The last quote is the important point - preventing those bad outcomes that come even years after a stroke. Even while the search Swartz describes is going on, it highlights the need for you to keep a watch on your own health.

Blood test could help doctors drill down into stroke cause

A few postings back, I cited a recent report that a quick MRI might help stroke patients fare better. The idea, in essence, is that with proper, accurate information, better decisions can be made.

Now, there's another story in a similar vein - a new blood test could help doctors drill down into what caused a patient to have a stroke:

From the Bureau of Labor Statistics

Clinical trials are underway for what could be a first-of-its-kind blood test that would help doctors determine what caused a patient to have a stroke.

Developed by Cincinnati-based Ischemia Care, the test isolates RNA from whole blood and examines immune responses, with the goal of differentiating where an ischemic stroke originated in a patient’s body.

Again, better information, obtained quickly, could potentially guide treatment and, in turn, potentially produce better outcomes. This story is not over, but worth watching.

'What we've got here is failure to communicate'

Famous "Cool Hand Luke" quote: "What we've got here is failure to communicate."

That movie came out in 1967. But even now, we've still got failure to communicate - not in fiction, but in real life. Sometimes with deadly outcome. A recent article from MedlinePlus tells us that hospitals are often not alerted about incoming stroke patients

In the studies, researchers examined about 372,000 cases of acute ischemic stroke (caused by a blocked blood vessel to the brain) between 2003 and 2011. The patients were taken by ambulance to one of nearly 1,600 hospitals participating in a quality improvement program -- called "Get with The Guidelines-Stroke" -- launched by the heart/stroke associations.

One study, published in Circulation: Cardiovascular Quality & Outcomes, found that when EMS alerted hospitals about incoming stroke cases, the patients were diagnosed and treated more quickly. Fast diagnosis and treatment is critical because certain clot-busting drugs have to be given within 3 to 4.5 hours after the onset of stroke symptoms to be effective, according to the study."

But a second study found that EMS pre-notification of stroke patients happened in only 67 percent of stroke cases in 2011, a slight increase from 2003 when hospitals were notified in about 58 percent of cases. That study is published in the Journal of the American Heart Association.

"Despite national guidelines recommending pre-notification by EMS for acute stroke patients, it's disappointing that there's been little improvement," the senior author of both studies, Dr. Gregg C. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles, said in an American Heart Association news release. "However, with these powerful new findings demonstrating substantial benefits with pre-notification, we have a tremendous opportunity to make positive changes in this component of stroke care."

So - when communication happens, we get better treatment. However, most of the time, that communication doesn't happen. That must change.

Stroke info research tool

How does your county stack up in stroke statistics - how many and their outcomes, plus details of income, race, age and more, and how those factors might influence those numbers.

The U.S. Centers for Disease Control and Prevention just launched an interactive atlas of heart disease and stroke:

CDC's Division for Heart Disease and Stroke Prevention has created the Interactive Atlas of Heart Disease and Stroke, a new online mapping tool that documents geographic disparities in the burden of cardiovascular disease (CVD) at state and county levels. Users can create county-level maps of nine different CVD outcomes, by sex, race/ethnicity, and age group, and can overlay maps with congressional boundaries and locations of health-care facilities. Users also can view maps showing county-level social determinants of health and health services, including poverty, education, and food acquisition determinants.

The Interactive Atlas of Heart Disease and Stroke is available at http://apps.nccd.cdc.gov/dhdspatlas.

Medicare shortchanges hospitals on stroke therapy

Interesting look on an issue that will eventually have to be reconciled. Reuters reported that Medicare shortchanges hospitals on stroke therapy:

They found that between 2001 and 2008, it typically cost U.S. hospitals $14,100 (in 2008 dollars) to care for a tPA patient who had a "good outcome." If the patient suffered serious complications from the stroke or died, the typical cost was around $19,000.

But the average Medicare payment for patients with a good outcome was $10,000, and just over $13,800 for patients who had disabling strokes.

In an earlier study, the same researchers had found that hospitals generally lose money on Medicare reimbursements for another stroke treatment - endovascular embolectomy, in which doctors go in and extract the blood clot causing the stroke.

... But over the long term, some hospitals might decide they don't want to invest in being stroke treatment centers.

"It could affect availability (of tPA) if some hospitals lose interest in treating a disease they are losing money on," Cloft said.

Watching out for the details may help

The right treatment might be the key to success. A recent story gave the results of Australian research showing that certain after-stroke treatments may boost outcome:

"Clinical leaders of stroke services can adopt this strategy with confidence that their outcomes will improve," Sandy Middleton, a professor at the Nursing Research Institute at St. Vincent's & Mater Health in Sydney, Australia, and colleagues wrote in the report in the Oct. 12 online edition of The Lancet.

The researchers noted that patients who recover in units devoted to stroke care often experience fever (20 to 50 percent of patients), high blood sugar (up to half of patients) and problems swallowing (37 to 78 percent of patients) within the first few days of a stroke. These conditions "are not yet universally well managed," the study authors indicated.

In the study, Middleton and colleagues randomly assigned patients at 19 stroke units in New South Wales, Australia, to different types of treatment. Some followed existing guidelines, while others adopted new protocols involving monitoring of fever and high blood sugar plus treatment for the conditions. Nurses also underwent special training to treat swallowing problems in the patients.

Within 90 days, 42 percent of the 558 patients in the group that received the special treatment were dead or considered to be dependent, compared with 58 percent of the 449 patients who received the existing treatment, the investigators reported.

Patients who received the special treatment also scored better on a test of their physical functioning, the results showed.

This also shows the value of an advocate for every stroke patient to help manage these conditions - fever, blood sugar and problems with swallowing. My wife was my advocate after my stroke, when I could not, literally, speak for myself. I'm convinced that her efforts greatly improved my outcome. Thank God for my advocate.

(Photo from the National Institutes of Health)

With the wing, comes hope; with hope, comes strength

"[B]ut those who hope in the LORD will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint."

-Isaiah 40:31

I'm guessing you recognize this from a longer quotation, from Isaiah 40:28-31. I don't have any stats to back it up, but this has to be one of the most quoted verses in the Bible.

It's quoted because it's comforting. And who doesn't need that? It's about hope strengthening faith, and with a renewed strength in faith, so much is possible. Pray today for someone struggling with stroke outcome - pray for a renewal of hope and strength in faith.