A. Kasmia, M.Sc., M.D.

Baldwin Neurology, LLC, 188 Hospital drive Suite 300, Fairhope, Al 36532.

Phone (251)-990-1910, Fax (251)-990-1911

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STROKE

 

Treating new stroke may be easier using Despmoteplase + MRI

New evidence from recent studies point the possibility of treating acute stroke up to 9 hours after onset.  Currently the only available acute ischemic stoke treatment is tPA with its restricted time window of 3 hours after the onset of ischemic stroke.  Despmoteplase (vampire bat saliva derivative) has shown some promise in busting clots within the cerebrovascular system safely up to 9 hours after onset.  Additionally this substance seems to carry less potential for being toxic to the nervous system. MRI scans can be used to select patients with more variable brain tissue ( benefit the most) and to help reduce the likelihood of untoward adverse effects. Link

 

Ultrasound may aid in clot-busting in acute stroke

Using tPA to treat acute stroke may be enhanced by the use of transcranial ultrasound , according to a recent study published in the New England Journal of Medicine. Ultrasound seems to help tPA in dissolving clots inside the occluded artery.  Study results 3 months after treatment suggest a potential for significantly improving acute stroke treatment outcome. Roughly half of tPA-alone treated patients have less than optimal outcome due to lack of complete dissolution of the blood clot.   More studies are needed to further evaluate this modality.  Link

Choosing an antiplatelet agent:    
  TIA or Stroke High Vascular Risk Risk of bleeding Headaches
ASA only 13%  or 10/1000/year 19% Reduction Nonfatal 1/1000/Year, Cranial 1/1000/3Years Low
Clopidogrel only Same as Aspirin 8.7% vs. Better than Aspirin Less than Aspirin Low
Dipyridamole only 13% Reduction 10% reduction Same as placebo High risk
Dipyridamole + ASA 15% Reduction Same as Aspirin Same as Aspirin High risk (6%)
Aspirin + Clopidogrel About same as ASA Same as Aspirin More than Clopidogrel alone Low

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