Erlanger Hospital Services

Erlanger Southeast Regional Stroke Center

FOR MEDICAL PROFESSIONALS

FOR PATIENTS

Stroke Busters: Revolutionizing Stroke Treatments

By Tom Devlin, M.D., and Blaise Baxter, M.D.

The Southeastern states comprise the “stroke belt,” the region with the highest incidence and mortality of stroke in the United States. Located in the heart of stroke belt, Tennessee has the third-highest stroke death rate in the country. In fact, only one other hospital in the nation treats more stroke patients than Erlanger.

The good news is that Erlanger is leading the way as a national model for acute stroke treatment and prevention, changing the lives of dozens of stroke victims each year.

Stroke

Strokes—sometimes known as “brain attacks”—occur when the blood vessels to the brain become narrowed, clogged, or rupture, resulting in the lack of blood flow to brain cells.

The earlier one reaches the hospital, the better the outcome. The first stroke therapy approved by the Food and Drug Administration (FDA), the drug tPA, must be administered within three hours after the first signs of stroke. Once the three-hour “golden window” closes, tPA is no longer a viable treatment option.

Now, however, several new approaches hold enormous promise for stroke prevention and treatment. Numerous treatments have been approved for medical use or are close to approval by the FDA. These drugs and medical devices can stop an acute stroke and reverse many of the most ravaging effects in the hours immediately after symptoms begin. Here is a look at some of the revolutionary treatment options available at Erlanger.

Interventional techniques

Most of the new stroke treatments involve non-surgical procedures known as “interventional” therapies. An interventional procedure involves threading a tiny tube known as a catheter up through the body from a small puncture site in the groin. Once the catheter reaches the delicate brain arteries, tiny medical devices like the “Merci retriever” can remove a blood clot from a blocked artery in the brain to restore blood flow.

Another interventional therapy involves placing a stent in a brain artery. The “wingspan” stent is designed for those who have had a stroke because of blocked brain arteries and who haven’t responded to traditional clot-busting therapies such as blood-thinner medications or aspirin. This thin, wire-mesh “wingspan” tube is designed to unclog arteries by popping open inside the fragile blood vessels in the brain.

Blood chilling

Another revolutionary stroke treatment at Erlanger stems from a clinical study called the “Cool-Aid Trial.” This hypothermic treatment involves lowering blood temperatures to salvage the brain. A chilled catheter cools the surrounding blood as it flows to the brain and limits the extent of injury. This “cool” protocol has become so successful that it’s used to treat patients with cardiac arrest. Erlanger was one of only five stroke centers in the world to participate in the landmark “Cool-Aid” study.

Clinical trials and research studies

A synthetic version of vampire bat saliva (yes, you read that correctly—the saliva of vampire bats) is in late-stage studies at Erlanger to determine its effectiveness in disintegrating blood clots that cause stroke. Eventually drugs like these might be used instead of or along with a mechanical clot extractor to soften up obstructions. This drug has the potential to be effective even if it’s administered up to nine hours after the onset of stroke symptoms.

A “miracle” drug designed to rapidly repair ruptured blood vessels is also being studied in clinical trials at Erlanger. This compound, already in use to treat other bleeding disorders, acts as a self-sealing, puncture repair drug.