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Stroke: Medical Crisis!



The saddest brainstorm

Risks and hazards

Treatment Conundrum

Big hopes, big flops

Clot clout.















Courtesy of Charlie Lester's Ethereal Esoterica.



Just zap it
Given all the problems with clot-busting, could we whip clots with the space cadet's favorite weapon, the laser?ZAP IT!

Wayne Clark of the Oregon Stroke Center laser-zapped clots in five patients 8 to 24 hours after strokes. While the results were preliminary, he calls them "very promising. We have achieved complete vessel reopening in some patients, while in others, treatment was not possible due to difficulties getting to the clot with the laser-tipped catheter." A slightly larger test is underway.

As in Star Wars, the movie, these lasers vaporize their targets. As in Star Wars, the missile defense, they only attack red targets, ignoring the white lining of the blood vessel. And since they only whack stationary targets, moving blood cells are also ignored.

The laser could help patients who reach the hospital too late to get TPA. "It is still true that 'time is brain,' but we hope that through treatments like this one, we can provide a longer time window for stroke treatment," Clark says.

Lasers are not the only bright idea for eradicating clots. Ultrasound zappers, reamers, and even vacuum cleaners are all under consideration or testing.

woman cleaning dogWeirded out by the idea of Hooverizing your brain arteries? What if drugs for heart and circulatory problems also prevented stroke as a helpful side effect?

Stroke of luck
The popular cholesterol-lowering drug Pravastatin seems to do just that. Robert Byington, a professor of epidemiology at Wake Forest University, says the 20 percent drop in ischemic (blockage) strokes was, "a big reduction that has widespread implications for the treatment of people with heart disease." The study will be published after the three smaller trials it describes are published. The results, however, may only apply to patients like those in the study, who had high cholesterol and/or heart disease.

The April issue of Stroke reported a 24 percent drop in strokes among elderly people who were treating irregular heartbeat with the blood thinner warfarin. The patients all had atrial fibrillation, yet only half were taking warfarin, the usual treatment for the condition. Author Brian Gage, of Washington University in St. Louis, called the low usage of warfarin "disappointing," particularly if the drug truly does prevent strokes as well as heart attacks.

Stroke of genius
Tomorrow, lots of treatments may be available for preventing and healing strokes. Today, stroke treatment is lagging. Only 1 to 2 percent of the 600,000 to 750,000 stroke patients "are being treated with the only drug ever proven without a doubt to work, says Felberg of the University of Texas. "It's a disgrace."

"The real problem," Felberg says, "is that until about five years ago, stroke was considered untreatable." Thus many elderly people, who get most strokes, do not know the symptoms, or the need to go immediately to the hospital.

Ignorant patients are one thing. But, Felberg, Clark and others in the brain-saving business, say many doctors and hospitals have not started treating strokes as emergencies. "Stroke is the third leading killer, and the number one cause of disability," Felberg says. "If you come into the emergency room with a stroke, you're not in pain, you're not complaining. If you come in with a knife wound to the abdomen, you're bleeding, screaming, and you get help right away. Yet the mortality of a knife wound to the abdomen is 5 percent, and the mortality of stroke is 20 percent. We should be treating stroke as we do a knife wound -- as an emergency."

Strike it rich with our stroke bibliography.


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