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

ces that aim to unblock occluded arteries (thrombolysis), interventions aimed at enhancing blood flow in the affected area through collateral channels and drugs or interventions aimed at lessening the damage produced by blocked vessels through neuroprotection. This can even include brain bypass surgery, a novel approach developed at the University of Pittsburgh.

"The goal in acute stroke therapy is to salvage the penumbra, or brain tissue that is threatened to progress to irreversible damage, but is not irreversibly compromised at the time of treatment. We measured the amount of already dead brain tissue, ischemic core, and the threatened brain tissue, the ischemic penumbra, and found that, irrespective of the point in time relative to symptoms onset, the penumbra is relatively constant, while the extent of core varies greatly," Dr. Jovin said.

"One implication of our findings is that selection of patients for acute stroke therapy based on determination of these parameters, especially on the extent of ischemic core, may be better than the currently used selection based on time," he said.

"The hypothesis remains to be proven in prospective studies using imaging technologies that will allow accurate identification of core and penumbra in acute stroke patients," he added.

Also participating in the study from the University of Pittsburgh were Howard Yonas, M.D., professor of neurosurgery; James M. Gebel, M.D., assistant professor of neurology, Lawrence R. Wechsler, M.D., professor of neurology and director of the UPMC Stroke Institute and Emanuel Kanal, M.D., professor of radiology.

Stroke is the third most common cause of death and a leading cause of chronic disability in North America, with more than 750,000 new cases occurring annually.

The UPMC Stroke Institute is dedicated to the treatment and prevention of stroke. At the Institute, UPMC doctors with a wide variety of specialties join together to offer the very late

Contact: Alan Aldinger
University of Pittsburgh Medical Center

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