Top Ten Advances in Stroke Research in 2010

1. “Time is brain”: Clot-dissolving treatment for acute ischemic stroke found beneficial in the first 4.5 hours after onset, potentially harmful later

A combined patient analysis of eight trials of intravenous tissue plasminogen activator (tPA) for acute ischemic stroke reinforced prior findings of a strong time-to-treatment effect, with greatest benefit in the first few hours after onset, and, for the first time, demonstrated increased mortality from late treatment beyond 4.5 – 6 hours after onset.

·  Pooled analysis of the ECASS, ATLANTIS, NINDS and EPITHET trials – Lancet, May 15, 2010; http://www.thelancet.com; Lancet 2010;375(9727):1695-703; Funding: There was no funding source for this study.

2. New mechanism of emboli clearance from the brain vasculature discovered

This study identified an entirely new way by which brain blood vessels are kept open by the body in the face of clots – extravasation. Clots that are not able to be dissolved are sometimes pushed out through blood vessel walls into the surrounding tissue, restoring nourishing flow in blood vessels.

·  Lam, et al; Nature, May 27, 2010; http://www.nature.com. Nature 2010;465:478-482; Funding: No funding sources were listed.

3. Carotid endarterectomy and carotid artery stenting directly compared

The large CREST trial compared head-to-head the two major methods to reopen narrowed carotid arteries carrying blood flow to the brain: carotid endarterectomy (open surgical repair) and carotid stenting (endovascular placement of a stent). Overall, both techniques had similar rates of success and complication, but among younger patients, under 70 years of age, stenting appeared advantageous while among older patients endarterectomy appeared advantageous. Those findings were also supported in a preplanned meta-analysis of individual patient data from three randomised controlled trials.

·  CREST – New England Journal, July 1, 2010; http://www.nejm.org; N Engl J Med 2010;363(1):11-23; Funding: National Institute of Neurological Disorders and Stroke (NINDS).

·  Carotid Stenting Trialists’ Collaboration – Lancet, Sept. 10, 2010; http://www.thelancet.com; Lancet 2010;376:1062-73; Funding: Medical Research Council, the Stroke Association, Sanofi-Synthe’labo, European Union.