A $25.9 million grant to two Atlanta medical institutions will be used to study a novel and minimally invasive treatment for the most deadly form of stroke, known as intracerebral hemorrhages.
The Atlanta-based grant recipients — Emory University School of Medicine and Grady Health System’s Marcus Stroke and Neuroscience Center — will test whether the procedure is effective at removing blood clots in the brain’s deepest recesses, Emory said in a news release.
The research taking place in Atlanta is of critical importance to people across the Peach State, experts told The Atlanta Journal-Constitution, because Georgia has some of the nation’s highest rates of stroke.
The vast majority of strokes in the U.S. are due to blockages of an artery, but about 13% of strokes are caused by a brain hemorrhage — and these are especially deadly. Up to 50% of people who suffer from hemorrhagic strokes will die within 30 days. Globally, about 30% of strokes are hemorrhagic, and about 60% of such strokes are caused by high blood pressure.
Credit: The Stroke Awareness Foundation
Credit: The Stroke Awareness Foundation
According to the Georgia Department of Health, Georgia sits within the “stroke belt,” an area in the Southeastern U.S. with stroke death rates that are approximately 30% higher than the rest of the U.S. The coastal plains of Georgia are in the “buckle” of the Stroke Belt, an area with stroke death rates about 40% higher than the rest of the nation.
The Emory doctor leading the trial, known as REACH, said the new, minimally invasive technique honed through ongoing research funded by the Marcus Foundation has the potential to shorten ICU stays for stroke recovery at Grady, where stays can sometimes stretch beyond two weeks.
“This initiative represents a significant step forward to advance hemorrhagic stroke treatment,” said Dr. Gustavo Pradilla, a neurosurgeon who is leading the research at Emory University.
In addition to Pradilla, the REACH trial principal investigators include Dr. Jonathan Ratcliff, associate professor of emergency medicine at Emory University School of Medicine and director of neurocritical care at Grady Health System; and Alex Hall, assistant professor of emergency medicine and director of clinical trials at the Emory University School of Medicine.
REACH aims to build on the work of a previous trial, known as ENRICH.
The ENRICH trial ended earlier this year, and its findings were noteworthy for having proved the novel surgical technique to remove blood clots due to hemorrhages not only did so effectively, but also cut recovery times in some cases to days, the AJC reported in April.
Pradilla told the AJC the new technique represents a paradigm shift because it routes a small tool via a small incision into the brain in order to reach and then remove blood clots resulting from the hemorrhage. Previously, the standard operation to remove blood clots in the brain entailed a conventional craniotomy — a large skin incision, removal of a section of skull and then the arduous process of reaching the actual blood clot. That process could entail suctioning out or transecting brain tissue, leaving open the potential for additional brain damage from the surgery itself.
During this latest trial, the team will take lessons learned treating hemorrhages in an area of the brain closer to the skull and apply them to stokes that occur in a deeper area of the brain known as the basal ganglia.
Hemorrhagic stroke occurs when a weakened vessel ruptures and bleeds into the surrounding brain. The buildup of blood inside the skull can crush brain tissue and cause damage.
Just as occurred in the ENRICH study, the REACH study will use two medical devices made by Indianapolis-based Nico Corporation. One tool, called the BrainPath, looks like a screw and essentially moves brain tissue to the side to avoid damage. A second tool, known as the meniGLIDE, removes the hard bits of blood, or the clot, via suction.
The ENRICH study found the procedure was most effective if performed within 24 hours of stroke. That’s because the brain recognizes blood clots as foreign bodies — and in seeking to remove them, it essentially attacks the clots, leading to inflammation that creates pressure in the skull and, in many cases, death. Prior to the ENRICH study, it was unclear if the benefit to the patient outweighed the risk of surgery.
The REACH trial will enroll approximately 600 patients at up to 60 stroke centers nationwide over four years, with enrollment targeted to begin in December. It will also establish a data repository to guide future clinical practices, Emory said in a news release.
Since 2008, The Marcus Foundation has awarded more than $72 million to the Emory/Grady team to advance stroke research, prevention and treatment.
“After witnessing the staggering death and disability strokes cause, I knew we had to do more to discover new treatment options,” says Bernie Marcus, founder of The Marcus Foundation and co-founder of Home Depot. “Breakthroughs like this new approach for the deadliest form of stroke and others made by the stellar team at the Marcus Stroke & Neuroscience Center will save and change lives around the world for decades. That’s a remarkable philanthropic return on investment.”
Stroke facts
In the United States, about 795,000 people suffer a stroke each year and there are more than 140,000 deaths each year from stroke.
Stroke is also the leading cause of serious long-term disability in the United States. There are over 7 million stroke survivors living in the U.S. and two-thirds of them are currently disabled. Around 25% of people who recover from their first stroke will have another within five years.
To prevent stroke, the Stroke Awareness Foundation recommends these steps:
Work closely with your doctor to control conditions that raise your risk, such as high blood pressure, high cholesterol, atrial fibrillation and diabetes.
If you smoke, stop. The risk of ischemic stroke in current smokers is double that of nonsmokers.
Drink alcohol sensibly. Regular heavy drinking can raise blood pressure.
Eat a healthy diet. This includes decreasing or eliminating saturated and trans fats, lowering sodium intake to about 2,000 mg daily, and eating more fruits and vegetables. Most processed and fast foods should be avoided.
Exercise regularly. Exercise has many beneficial effects on our heart and blood vessels, such as strengthening the heart muscle, increasing oxygen intake, lowering blood pressure and keeping weight down.
Lower stress levels. Although a certain amount of stress is unavoidable, stress contributes to high blood pressure. By managing stress with exercise, relaxation techniques and counseling, if needed, stroke risk may be reduced.
Source: The Stroke Awareness Foundation
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