The School of Medicine will receive about $9 million over five years to investigate new ways to diagnose and treat stroke. The new research center will become part of a national network of stroke centers.
The National Institute of Neurological Disorders and Stroke (NINDS) is providing the grant, which will help establish a Specialized Program for Translational Research in Acute Stroke (SPOTRIAS) Center at the school and Barnes-Jewish Hospital.
“The overall aim of the program is to focus on new diagnostic and treatment tools for the first minutes and hours after a stroke, which is the critical window where we can make a big difference,” said principal investigator Colin Derdeyn, M.D., professor of radiology, of neurology and of neurological surgery.
The NINDS requires that SPOTRIAS centers have a proven record for efficient, high-volume acute stroke treatment. For the WUSTL and Barnes-Jewish stroke treatment team, the time between a potential stroke patient’s arrival at the hospital and administration of the clot-busting drug tissue plasminogen activator (tPA) is 45 minutes.
“That’s one of the best times in the nation, and that means our patients have much better chances of surviving with relatively little or no brain damage,” Derdeyn said.
WUSTL’s reputation as a leader in radiology also made it a strong contender for the grant, Derdeyn said. Barnes-Jewish houses a new multimillion-dollar imaging center dedicated to research, and researchers plan to use it to develop new ways to assess the brains of stroke patients.
For more than a decade, the top priority in such assessments has been learning if patients were suffering strokes triggered by blood-vessel blockage (ischemic stroke) or bleeding from a blood vessel (hemorrhagic stroke). Ischemic strokes can be treated with tPA, but the drug’s clot-busting effects make it inappropriate for hemorrhagic strokes.
Given the small risk of increased bleeding associated with tPA, doctors want to fine-tune its use by getting more information about when the drug can and cannot help. While there is already an effective technique to identify dead brain tissue, a stroke center team led by Jin-Moo Lee, M.D., associate professor of neurology, will develop an approach to discover what brain tissue continues to survive.
The second project, led by Michael Diringer, M.D., director of the neurology-neurosurgery intensive care unit at Barnes-Jewish, involves patients with hemorrhagic stroke from ruptured brain aneurysms. Patients can survive such hemorrhages only to die or be seriously injured up to 10 days later by vasospasm, an aftereffect that causes the blood vessels of the brain to suddenly constrict. Diringer and his colleagues will look for ways to block vasospasm.
In the third project, Derdeyn will lead a preliminary trial to assess the safety of giving tPA to patients with ischemic strokes beyond the usual cutoff time of three hours post-stroke.