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March 2008 Issue

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Neurology Researcher Honored for Ischemic Stroke Findings

Published March 2008

Stroke is the third leading cause of death and the leading cause of major disability in the United States. Successfully treating ischemic (restricted blood flow) stroke is dependent on how quickly treatment is given to break up the blood clots that clog key vessels and cause this disease.


UC's neurology department has been a leader in developing stroke treatment since the early studies of tissue plasminogen activator (t-PA), the only U.S. Food and Drug Administration-approved treatment for acute ischemic stroke.


Intravenous t-PA has been found to be effective if administered within three hours of stroke onset, and more effective if given sooner.


Physicians are now investigating methods for directly dissolving or removing blood clots using a catheter in brain vessels, called the intra-arterial approach. Evidence has suggested that this method may be more effective than intravenous t-PA, but no data was previously available on how time to treatment affects this approach. 


Pooja Khatri, MD, assistant professor of neurology, had concerns that, at later treatment times, the brain may become irreversibly damaged, and the risks of the procedure would outweigh any benefit of restoring blood flow.


She led a research team that analyzed data from a multicenter international stroke trial coordinated by UC, which tested the safety of low-dose intravenous t-PA followed by intra-arterial treatments. They analyzed how the timing of when blood flow was restored affected the chance of a good recovery. 


Khatri's team found that the chance of a good outcome after opening a blood vessel became progressively less over time, and by about seven hours, approached the same outcome for a patient who didn't receive treatment.


"This is the first clear evidence that time is a strong determinant of outcome, even if a blood vessel is successfully opened," says Khatri. "It reinforces the notion that stroke treatments and stroke health care delivery must emphasize speed."


Study results were presented at the annual International Stroke Conference in February, and for her work, Khatri won the Robert G. Siekert New Investigator Award.


The award is presented annually in honor of Robert Siekert, founding chair of the American Heart Association's International Conference on Stroke and Cerebral Circulation.


Khatri is the second UC investigator to receive this award. Dan Woo, MD, of neurology, received the honor in 2004.


UC coauthors for Khatri's study include Todd Abruzzo, MD, Joseph Broderick, MD, and Thomas Tomsick, MD. 

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