Stroke is far more common than you might realize, affecting more than 795,000 people in the U.S. every year. It is a leading cause of death and long-term disability. Yet until now, treatment options have been limited, despite the prevalence and severity of stroke.
Not so long ago, doctors didn’t have much more to offer stroke victims than empathy, says Kevin Sheth, MD, Division Chief of Neurocritical Care and Emergency Neurology. “There wasn’t much you could do.” But that is changing. Recent breakthroughs offer new hope to patients and families.
Beating the Clock Think of stroke as a plumbing problem in the brain. It occurs when there is a disruption of blood flow, either because of a vessel blockage (ischemic stroke) or rupture (hemorrhagic stroke). In both cases, the interruption of blood flow starves brain cells of oxygen, causing them to become damaged and die. Delivering medical interventions early after a stroke can mean the difference between a full recovery and significant disability or death. Time matters.
Unfortunately, stroke care often bottlenecks in the first stage: diagnosis. Sometimes, it’s a logistical issue; to identify the type, size, and location of a stroke requires MRI imaging, and the machinery itself can be difficult to access. MRIs use powerful magnets to create detailed images of the body, which means they must be kept in bunker-type rooms, typically located in hospital basements. As a result, there is often a delay in getting MRI scans for stroke patients.
Dr. Sheth collaborated with a group of doctors and engineers to develop a portable MRI machine. Though it captures the images doctors need to properly diagnose stroke, it uses a less powerful magnet. It is lightweight and can be easily wheeled to a patient’s bedside. “It’s a paradigm shift – from taking a sick patient to the MRI to taking an MRI to a sick patient,” says Dr. Sheth.
Stopping the Damage Once a stroke has been diagnosed, the work of mitigating the damage can begin.
“Brain tissue is very vulnerable during the first hours after stroke,” says vascular neurologist Nils Petersen, MD. He and his team are using advanced neuro-monitoring technology to study how to manage a patient’s blood pressure in the very acute phase after a stroke.
Dr. Petersen’s research shows that optimal stroke treatment depends on personalization of blood pressure parameters. But calculating the ideal blood pressure for the minutes and hours after a patient has a stroke can be complicated. It depends on a variety of factors—it is not a one-size-fits-all scenario.
Harnessing the Immune System Launching an inflammatory reaction is how the body responds to injury anywhere in the body – including the brain, following stroke. However, in this case, the resulting inflammation can sometimes cause even more damage. But what if that immune response could be used to the patient’s advantage?
“We’re trying to understand how we can harness the immune system’s knowledge about how to repair tissues after they’ve been injured,” says Lauren Sansing, MD, Academic Chief of the Division of Stroke and Vascular Neurology.
Her team is working to understand the biological signals guiding the immune response to stroke. That knowledge can then direct the development of targeted therapeutics for the treatment of stroke that minimize early injury and enhance recovery.
“We want to be able to lead research efforts that change the lives of patients around the world,” says Dr. Sansing.
Learn about these developments and more in the video above.
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11.29 -> - The stroke is a very common disease,
13.93 -> the brain is not getting enough blood flow
15.55 -> because either a blood vessel
becomes hardened and narrowed,
19.04 -> or it's blocked by a
blood clot or it ruptures
22.39 -> or it ruptures because the blood vessel
wall becomes weak leading
24.87 -> to bleeding within the
brain or around the brain.
28.88 -> - Time is critical in these situations
31.18 -> because the longer a blood
vessel stays blocked,
34.25 -> the more brain cells will die.
37.41 -> - There's few things more devastating
39.47 -> than a patient having a stroke.
41.07 -> It affects their identity,
their ability to be productive.
46.05 -> Decades ago when you see
somebody with a stroke
48.63 -> you would provide your empathy
50.06 -> and then you'd have to move on
51.13 -> because there wasn't much to offer.
53.21 -> Doing stroke research,
investing in stroke treatments
56.139 -> was thought to be a
graveyard that's changing.
59.06 -> This is reinvigorating stroke research
61.69 -> very broadly speaking.
64.01 -> - There's an urgency to diagnose
66.32 -> through clinical
evaluations and neuroimaging
69.26 -> and then offer the best treatments
70.66 -> that we can for these patients.
72.81 -> - Getting those therapies earlier,
75.08 -> results in better outcomes.
77.98 -> Earlier is important, time matters.
90.38 -> When you think about stroke,
91.78 -> one of the fundamental
things that you need to do
94.4 -> is figure out what kind of a
stroke patients are having.
97.74 -> The only way you can figure that out,
100.07 -> is by taking a look with a brain image
102.45 -> and MRIs is incredibly safe technology.
105.47 -> It's very powerful
106.63 -> but because of high magnetic
field and power requirements,
110.96 -> it's usually in a basement.
112.64 -> And as a result, even
though it's very important,
115.51 -> very difficult for patients to access.
119.04 -> Here at Yale, for the
first time in the world
121.59 -> both developed and deploy
a portable MRI machine.
126.59 -> We've taken MRI from that secure bunker,
128.97 -> and we've brought it to the bedside
131.46 -> and this has been incredibly
exciting as you can imagine.
134.15 -> The pictures are getting
better and better,
136.51 -> and we're constantly
coming up with new ideas
139.36 -> for what we can do with a
very exciting technology.
147.928 -> - Under normal circumstances,
149.32 -> the brain has the unique
ability to regulate
151.61 -> its own blood flow.
152.96 -> Brain tissue is very vulnerable
during the first hours
155.81 -> after stroke.
157.03 -> How do we manage blood pressure
in the very acute phase
160.28 -> after someone has had a stroke?
162.37 -> The ideal blood pressure after
someone has had a stroke,
165.59 -> depends on many factors.
167.65 -> So using a one size fits all approach
170.12 -> for blood pressure
management after stroke,
172.09 -> it's likely inadequate.
173.42 -> We're currently using
neuromonitoring technology
177.28 -> that helps us identify the
blood pressure that's ideal
181.52 -> for this individual person,
183.19 -> so that the brain has the best chances
185.26 -> to heal from the stroke.
192.44 -> - When there's injury
anywhere in the body,
195.24 -> the body sets up an inflammatory reaction.
197.86 -> The same thing happens in the brain.
199.89 -> And so we're trying to understand
200.96 -> how can we harness the
immune systems knowledge
204.56 -> about how to repair tissues
after they've been injured.
208.09 -> Once you've dealt with the
initial blood vessel problem
211.2 -> either stopped the bleeding,
212.5 -> or reopened the blocked blood vessel,
215.33 -> we now have a lot of injury
that's still ongoing over days.
219.04 -> By understanding what the signals are
222.27 -> that tell the immune system
223.76 -> to stop making pro-inflammatory factors,
226.37 -> and start making growth factors,
227.94 -> and start healing the brain,
229.51 -> we can find new therapies, new treatments
231.69 -> for patients with stroke that
minimize that early injury
234.83 -> and really enhance their
ability to recover.
238.6 -> - Those patients that come
back from a severe stroke,
242.43 -> to go on and live a
normal, meaningful life,
245.37 -> that's really inspiring,
246.59 -> even though we're up
against a terrible disease,
250.02 -> but we're making progress.
251.48 -> We're constantly getting better
and improving the therapies,
254.21 -> and that's because of clinical research.
261.52 -> - What motivates me is that the
interventions and treatments
266.21 -> that we were evaluating
and studying 10 years ago,
268.92 -> are now part of a standard
of care, a clinical practice
272.8 -> which is enabling us to reduce death
275.17 -> and disability to our patients.
277.63 -> - What motivates me in the research realm
279.89 -> is thinking that at some point,
281.85 -> maybe one of the discoveries
that we make in lab,
283.95 -> can actually translate into a new therapy
286.18 -> that would allow a patient to walk again
287.85 -> or speak again, or return
to their normal lives.
290.63 -> - There's always something
nice about trying
292.95 -> to attack something that
people say can't be done.
295.6 -> We're gonna spread towards those areas
298.41 -> because they're important,
299.83 -> and because we like to
do the unique thing.
302.26 -> - We want to be able to
lead research efforts
305.15 -> that change the lives of
patients around the world.
