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Downstate Times

The Newsletter for SUNY Downstate
University Hospital of Brooklyn

Stroke Research at Downstate
Finding Better Treatments for Neurological Emergencies

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Research team members (l. to r.): Sarah Zelonis, senior research support specialist; Dr. Steven Levine; Dr. Clotilde Balucani; and Saroj Kunnakkat, senior research support specialist.

Downstate Times previously reported that Downstate was awarded the Gold Plus Achievement Award by the American Heart and Stroke Associations for superior stroke patient care. As one of the most advanced centers for research on stroke, Downstate provides both the best current treatments for stroke and an opportunity for patients to participate in clinical trials that may offer even more effective, long-lasting therapies.

Downstate has been designated a regional "hub" of the National Institutes of Health Neurological Emergencies Treatment Trials (NETT) network. Steven R. Levine, MD, professor of neurology and emergency medicine, is principal investigator (PI) for NETT's site at Downstate; Richard Sinert, DO, is the PI for emergency medicine (EM).

"Frequently, there is a narrow window of opportunity to successfully treat neurological damage following a stroke," says Dr. Levine. "As part of NETT, we work with paramedics and emergency room staff to evaluate new treatments and identify patients who might benefit from them." Downstate NETT investigators from EM include Drs. Ethan Brandler, Ashika Jain, Lorenzo Paladino, Jennifer Martindale, Pia Chatterjee; and Eric Legome; from Neurology: Drs. Helen Valsamis, Arthur Grant, Adrian Marchidarin, Alison Baird, Diana Rojas-Soto, and Volodymry Vulkanov; Motria Mishko is the research pharmacist for NETT treatments.

Recruitment is currently underway for the following clinical trials:

ATACH II – Antihypertensive Treatment of Acute Cerebral Hemorrhage
Does more intensive treatment for high blood pressure produce better results in preventing damage from brain hemorrhage? Conducted at Downstate and Kings County Hospital Center, this study will provide one group of subjects high-dose medication to reduce blood pressure; the other group will receive the standard treatment. Both groups will be treated with intravenous Cardene (nicardipine).

ARTTS 2 – Randomized Controlled Trial of Argatroban with tPA for Acute Stroke
Tissue plasminogen activator (tPA) is a clot buster used to treat stroke. This clinical trial, conducted at Downstate, will assess the benefit for stroke patients treated with tPA to also receive Argatroban. One group of patients will receive high-dose Argatroban, one will receive a low-dose treatment, and the third neither—just TPA.

POINT Trial – Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke
More than 250,000 transient ischemic attacks (TIA) are diagnosed each year. Although they are short-lasting, they are often harbingers of a more serious, debilitating stroke. This trial will assess whether treatment with aspirin in combination with the blood thinner Plavix (clopidogrel) is more effective than using aspirin alone to prevent an ischemic event. It will also evaluate whether such combination therapy significantly increases the risk of serious bleeding.

SHINE – Stroke Hyperglycemia Insulin Network Effort
Can tighter glycemic control for patients with high blood sugar (hyperglycemia) reduce stroke severity and disability? Participants for this acute trial will be recruited among hyperglycemic patients at Downstate and KCHC who had a stroke in the previous 12 hours.

ProTECT III – Progesterone for the Treatment of Traumatic Brain Injury
Phase 3 of this clinical trial will determine if administering progesterone, along with the standard medical care, is neuroprotective for limiting damage caused by traumatic brain injury.

In addition to these national trials, Clotilde Balucani, MD, PhD, a postdoctoral fellow in neurology, is analyzing outcomes for patients who have suffered mild and rapidly improving stroke. "Often patients who come to the ER after having a mild stroke seem to improve and are not offered treatments that might prevent symptoms from worsening later on," she explains.

Dr. Levine is enthusiastic about the future of stroke medicine.

"New and improved methods are being developed to treat stroke," says Dr. Levine, "but medical residents, nurses, and other caretakers must be taught to recognize the symptoms of stroke and initiate treatment immediately." He would like them to also be familiar with the research going on here so that they can help raise awareness and recruit participants for these important clinical trials.

"If you see a patient you think may be eligible for our acute trials, please call the hotline number posted in the KCHC and UHB EDs or Neurology On-Call rooms."