If you're having a stroke, it's crucial that you get medical help as quickly as possible.  The right treatment can mean the difference between life and death, and reduce future impairment.  Now, doctors are testing a possible new, medical breakthrough for stroke victims.

Every second counts when you suffer a stroke. 

"One side of the body doesn't work. They can't speak. They can't see,” Arthur M. Pancioli, MD FACEP, Professor and Chairman in the Department of Emergency Medicine, University of Cincinnati, College of Medicine, told Ivanhoe.

Most strokes are caused by a blood clot that blocks the flow of blood to the brain. If you get help within three hours, you can get a drug called TPA, but Dr. Pancioli, an expert in emergency medicine, warns of the risks. 

“With that drug, one in about 16 patients that you treat will have bleeding into the brain,” Dr. Pancioli said.

Dr. George Shaw and researchers at the University of Cincinnati, College of Medicine are testing a breakthrough technique to dissolve human blood clots more quickly, without the risk of bleeding. 

They’re using a natural enzyme called plasmin.

“It’s the most effective therapy we've ever looked at,” George J. Shaw, MD, PhD, Emergency Medicine Associate Professor, University of Cincinnati, College of Medicine, told Ivanhoe.

The plasmin is loaded into a special bubble called a liposome. Through an IV, they send it directly to the blood clot.

"We pop that bubble with an ultrasound pulse and release the plasmin right where you want it,” Dr. Shaw said. "I think it's going to be a major step forward for stroke therapy.”

And it could be a major breakthrough for the millions of people who suffer a stroke. 

As with TPA, doctors would still need to give the plasmin within three hours of the onset of stroke. Clinical trials with plasmin could start in five years.


BACKGROUND: A stroke may also be considered a brain attack that happens when a blood clot blocks an artery. This prevents blood flow from the heart to the body causing dead brain cells and brain damage. When a stroke occurs, the abilities that are controlled by that part of the brain are lost due to the damaged brain cells. Motor functions such as memory, movement, and speech are all affected from a stroke and recovery is questionable. Recovery depends on the patient and the motivation to get better, as well as the location of the brain where the stroke occurred. (Source: http://www.stroke.org/site/PageServer?pagename=stroke)

PREVENTION: To prevent having a stroke, one might consider making a couple of lifestyle changes. Blood pressure, cigarette smoking, and alcohol are three main factors of how a stroke might occur. Cholesterol, diabetes, and weight can also be managed to be sure that you are not at risk. Transient Ischemic Attack (TIA), atrial fibrillation, and circulation are three conditions to be aware of when preventing a stroke. TIA is an incident that consists of stroke-like symptoms that last temporarily. 40 percent of individuals who experience TIA will have a stroke. (Source: http://www.stroke.org/site/PageServer?pagename=prevent)

SIGNS: The acronym F.A.S.T. was created to teach patients of potential stroke symptoms. “F” stands for face. If one side of the face is drooping while smiling, that could be a sign of stroke. “A” stands for arms; ask the person to raise their arms to see if one is also dropping. “S” is speech; ask the person to repeat a phrase and listen for slurring. “T” stands for time; use your time wisely if any of these signs occur and seek medical help. (Source: http://www.stroke.org/site/PageServer?pagename=prevent)

NEW TREATMENT: A new study from the University of Cincinnati College of Medicine has found that, when delivered via ultrasound, the natural enzyme plasmin is more effective at dissolving stroke-causing clots than the standard of care, recombinant tissue plasminogen activator (rt-PA). The delivery method involves trapping plasmin in bubble-like liposomes, delivering them to the clot intravenously and bursting it via ultrasound.  “That method is necessary,” UC associate professor of emergency medicine George Shaw III, MD, PhD, was quoted as saying, “because plasmin cannot be delivered through traditional methods. Intravenous delivery of rt-PA is designed to solve that problem by catalyzing the conversion of existing plasminogen inside the body to plasmin, which in turn degrades blood clots.”  In in-vitro study, Shaw and researchers enclosed plasmin and a gas bubble inside a liposome. Then, they delivered the liposome to a clot in an in-vitro lab clot model and dissolved it using ultrasound waves, thus delivering the plasmin enzyme to the clot. After 30 minutes, clots treated with plasmin showed significantly greater breakdown than clots treated with rt-PA. (Source: http://www.med.uc.edu/Home.aspx)


George J. Shaw, MD, Emergency Medicine Associate Professor at the University of Cincinnati, College of Medicine, talks about what could be medicine’s next big thing for treating stroke.

When a person suffers a stroke and goes to the ER, what is the standard of care now?  

Dr. Shaw: They would get appropriate labs drawn, an EKG, and a head CT.  CT stands for computed tomography.  It’s a special x-ray of the head where we can see the 3D structure of the brain. If we are worried about a stroke, we are either looking for blood, or possible signs of what we call an ischemic stroke.  Ischemic stroke is the kind of stroke that is caused by a blood clot and that’s about 80% of them.  In this area, we’ve got the ability to be able to call on the stroke team, which is a group of dedicated physicians.  They are based out of the University of Cincinnati and take care of stroke patients from about 13 hospitals in the area; so there is always somebody on call for that.  If you are going to have some kind of stroke, you want to be in this city. They can assist you in taking care of the patient and evaluating the patient.  Then, if the patient is actually having a stroke from a blood clot and it’s early enough, then they can be treated with TPA, or tissue plasminogen activator, the clot busting drug that folks have heard about.  

How does TPA work?  

Dr. Shaw: TPA converts plasminogen, a chemical present in the blood stream and in the clot and turns it into plasmin.  The plasmin is an enzyme that breaks up the clot.  It breaks up what’s called the fibrin mesh of the clot. 

Within how many hours of a stroke do you have to get TPA for it to be effective? 

Dr. Shaw: Within 3 hours of symptoms. This can be up to 4.5 hours in some limited circumstances.