Washington University School of Medicine in St. Louis will receive approximately $9 million over 5 years to investigate new ways to diagnose and treat stroke. The new research center will become part of a national network of stroke centers.
The National Institute of Neurological Disorders and Stroke (NINDS) is providing the grant, which will help establish a Specialized Program for Translational Research in Acute Stroke (SPOTRIAS) Center at the School of Medicine and Barnes-Jewish Hospital. Areas of study will include stopping a deadly aftereffect of brain bleeding known as vasospasm and developing new brain imaging techniques to better determine who is likely to benefit from intravenous doses of the clot-busting drug tissue plasminogen activator (tPA).
“The overall aim of the program is to focus on new diagnostic and treatment tools for the first minutes and hours after a stroke, which is the critical window where we can make a big difference, ” says principal investigator Colin Derdeyn, M.D., professor of radiology, neurology and of neurological surgery.
The other institutions in the SPOTRIAS research center network are the University of Cincinnati, University of Houston, University of California at Los Angeles, University of California at San Francisco, Columbia University, Harvard University, and a National Institutes of Health stroke treatment program in Washington, D.C.
“The hope is that this network will allow us to accelerate the testing of new approaches and bring those that are successful to the clinic more quickly,” Derdeyn says.
The NINDS requires that SPOTRIAS centers have a proven record for efficient, high-volume acute stroke treatment. For the WUSTL and Barnes-Jewish stroke treatment team, the “door-to-needle” time—the time between a potential stroke patient’s arrival at the hospital and administration of intravenous tPA—is 45 minutes.
“That’s one of the best times in the nation, and that means our patients have much better chances of surviving with relatively little or no brain damage,” Derdeyn says. “That quick turnaround is based on the hard work of a diverse community of health care providers, from paramedics in the field to emergency department physicians and nurses, radiologists and neurologists. We all work on greased skids to assess what’s happening and get things done as quickly as possible.”
Derdeyn says Washington University’s reputation as a leader in radiology also made it a strong contender for the grant. A new multimillion-dollar imaging center dedicated to research is located at the hospital, and researchers plan to use it to develop new ways to assess the brains of stroke patients.
For more than a decade, the top priority in such assessments has been learning if patients were suffering strokes triggered by blood vessel blockage (ischemic stroke) or bleeding from a blood vessel (hemorrhagic stroke). Ischemic strokes can be treated with tPA, but the drug’s clot-busting effects make it inappropriate for hemorrhagic strokes.
Given the small risk of increased bleeding associated with tPA, doctors want to fine-tune their use of it by getting more information about when the drug can and cannot help. An effective technique exists for identifying dead brain tissue, but a team at the new stroke research center led by Jin-Moo Lee, M.D., associate professor of neurology, will develop an approach to answer the equally important question of what brain tissue continues to survive.
“Some patients may have quite a bit of tissue that is still viable several hours after a stroke, while others will have extensive damage in a matter of minutes,” Derdeyn explains. “We want ways to triage patients that are based on an assessment of what can still be saved, not just on how much time has passed since the stroke. That will help us direct patients to the treatment option most likely to help.”
The second project, led by Michael Diringer, M.D., director of the neurology-neurosurgery intensive care unit at Barnes-Jewish Hospital, involves patients with hemorrhagic stroke from ruptured brain aneurysms. Patients can survive such hemorrhages only to die or be seriously injured seven to 10 days later by vasospasm, an aftereffect that causes the blood vessels of the brain to suddenly constrict. Diringer and his colleagues will look for ways to block this aftereffect, including clinical trials of statins, cholesterol-lowering drugs that may help reduce the risk of vasospasm.
The third branch of research funded by the NINDS grant will test a theory that strokes in blood vessels that supply the back of the brain may be treatable for a longer window of time. Approximately 10 to 20 percent of all ischemic strokes are thought to occur in these vessels, and studies have suggested the brain areas fed by them can survive longer with a diminished blood supply. Scientists led by Derdeyn will conduct a preliminary trial to assess the safety of giving tPA to these patients beyond the usual cutoff time of three hours post-stroke.
In addition to the research initiatives, the SPOTRIAS grant will fund other projects including educational programs to help increase awareness of the symptoms of strokes and the need for rapid treatment among paramedics and emergency department physicians.
Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.