Brain Scans Identify Stroke Patients

The National Institute of Neurological Disorders and Stroke (NINDS) as part of NIH, in recent years, funded a study www.ninds.nih.gov to identify a greater number of stroke patients who will be able to receive therapy later than previously believed.

News on the “Endovascular Therapy Following Imaging Evaluation for the Ischemic Stroke” (DEFUSE 3) study was presented recently at the International Stroke Conference 2018 in Los Angeles and details on the study were published on January 24, 2018 in the New England Journal of Medicine.

DEFUSE 3, a large, multi-site study receives support from NINDS “StrokeNet” which is a network of hospitals www.nihstrokenet.org, providing research information for multi-site clinical trials. The DEFUSE 3 study was conducted at 38 centers in the U.S and was led by Gregory W. Alvers, MD, Professor of Neurology and Neurological Sciences at the Stanford University School of Medicine and also Director of the Stanford Stroke Center.

Over the past two decades, scientists have been working to develop brain scanning methods called perfusion imaging to identify patients with brain tissue that can still be salvaged by removing the blockage. In perfusion imaging, a standard dye is injected and scanned for a few minutes as it passes through the brain.

Using an automated software known as RPID to analyze perfusion MRI or CT scans, the DEFUSE 3 researchers were able to identify patients thought to have salvageable tissue for up to 16 hours after stroke onset. The participants were randomized to either receive endovascular thrombectomy plus standard medical therapy or medical therapy alone.

The study demonstrated that physically removing brain clots up to 16 hours after symptom onset in selected patients has led to improved outcomes as compared to standard medical therapy. Walter Koroshetz M.D, Director for NINDS reports, “The study shows that one out of three stroke patients who present with at-risk brain tissue on their scans are able to improve and may be saved from what might have been a devastating brain injury.”

NIH ended the study early by NIH on the recommendation of the independent Data and Safety and Monitoring Board because of the overwhelming evidence of benefit from the clot removal procedure.

References: Albers GW et al. Thrombectomy for Stroke at 6 to 16 hours with Selection by Perfusion Imaging. New England Journal of Medicine www.nejm.org .January 24, 2018.

 

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