Prevention of Recurrent StrokePosted on December 11, 2008
Stenting & Aggressive Medical Management for the Prevention of Recurrent Stroke in Intracranial Stenosis
Stroke experts such as Dr. Lopes at Rush University Medical Center, agree that the best treatment for prevention of another stroke or TIA in patients with narrowing of one of the arteries in the brain is uncertain. Frequently, treatment of these patients involves the use of anti-clotting medications to prevent blood clots from forming in the narrowed vessel. Medications used for this purpose include aspirin and plavix. Patients typically remain on these medications for life.
Within the past few years, a new surgical treatment has been introduced. This intervention includes using a stent to prop open the diseased vessel in the brain, thereby allowing blood to flow normally. Patients undergoing stenting typically remain on the anti-clotting medications. This treatment paradigm continues to undergo further research.
Recent research has also indicated a benefit in prevention of recurring stroke by Intensive Medical Therapy, which is defined as treating risk factors for stroke like high blood pressure and elevated LDL (low density lipids – the “bad” form of cholesterol). This is done by:
- keeping the blood level of LDL (low density lipids) under 70
- keeping the systolic blood pressure under 140 (or 130 if you’re diabetic)
Also included in risk factor management is:
- if diabetic, keeping the hemoglobin A1c blood level under 7%
- if smoker, quitting smoking
- 30-45 minutes of moderate intensity activity 3-5 days a week (walking, jogging, cycling or other aerobic activity)
- weight control that will be measured by a calculation called a BMI (body mass index). See http://www.nhlbisupport.com/bmi/ to calculate your BMI. The goal is to have your BMI under 25 OR to have you lose 10% of your body weight if your BMI is already greater than 27.5.
Physicians nationwide, including Dr. Lopes at Rush University Medical Center, participating in the SAMMPRIS study will compare the safety and effectiveness of either Intensive Medical Therapy PLUS Stenting or Intensive Medical Therapy alone to prevent stroke, heart attack or death in patients with narrowed brain blood vessels.
The study will enroll patients over a 5 year period. Each participant will be involved in the study for a minimum of 1 year and a maximum of 3 years. Dr. Lopes anticipates enrolling approximately 20 patients at Rush University Medical Center.
Criteria for participating in the SAMMPRIS study include:
- Between the ages of 30 and 80
- Have had a TIA or non-severe stroke within 30 days of enrollment attributable to severe intracranial stenosis (Brain Artery Disease)
The following patients will be excluded from the study:
- Patients suffering a disabiling (severe) stroke
- Stroke was caused by bleeding (hemorrhage) or clot (thrombus)
- Patient received previous treatment of target vessel with a stent, angioplasty or other mechanical device.
This is a partial list of inclusion and exclusion criteria. Please call 312 563-4000 or email Dr. Lopes at info@ChicagoStrokeMD.com for more information or to inquire about enrollment in the study.