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Stroke treatment may come from physiological determinations not time frame, says Pitt

PITTSBURGH, Oct. 28 Determining the type of treatment for acute stroke caused by blockage of large vessels in the brain can best be decided by measuring both the amount of brain tissue that is threatened but not yet dead (ischemic penumbra) and the amount of brain that is already dead (ischemic core), according to groundbreaking University of Pittsburgh research published in the October issue of Stroke, a journal of the American Heart Association.

This view challenges the currently used selection methods for acute stroke therapy, which utilize time after onset of stroke as the main selection criteria.

The study supports the theory that patient selection for acute stroke therapy based on physiology rather than on time may lead to expansion of the therapeutic window, improved outcomes and fewer side effects than currently achieved. This approach requires early determination of both irreversible ischemic core and reversible penumbra in acute stroke.

The study was led by Tudor Jovin, M.D., assistant professor of neurology at the University of Pittsburgh School of Medicine and a member of the University of Pittsburgh Medical Center Stroke Institute. Researchers used xenon-enhanced CT scans, one of the few technologies that allows accurate quantitative cerebral blood flow measurement in human stroke, to evaluate 36 patients with middle cerebral artery (MCA) occlusion who were studied within six hours of symptom onset. They found that patient outcomes were correlated to core and penumbra and not to the time between stroke onset and the point in time at which they were studied.

The results indicated that doctors might be better able to treat patients with stroke if they know how much tissue is damaged beyond repair and how much might be salvageable. Currently most guidelines for treatment using recanalization, or re-opening blocked blood vessels, use time as the primary factor.

Treatment options in acute stroke include drugs or devi
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Contact: Alan Aldinger
AldiAL@upmc.edu
412-624-2607
University of Pittsburgh Medical Center
28-Oct-2003


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