DOCTORS in Glasgow are pioneering a radical new approach to the treatment of stroke patients that could revolutionise their care.
The new method aims to eliminate one of the main problems faced when victims first arrive in hospital – working out how long it has been since they suffered their attack.
Doctors have a window of four-and-a-half hours in which to give patients a clot-busting treatment. After this time, the dangers of the drug might outweigh the benefits.
However, patients are often unable to identify when their stroke occurred and just a small percentage are therefore able to have the treatment, which can help save brain tissue.
Dr Celestine Santosh, a neuroradiologist at the Glasgow's Southern General, is leading the development of a new system to identify which patients should have the treatment.
The procedure is also a therapy, helping reduce some of the disabilities caused by strokes.
It is hoped the system, called the Glasgow Oxygen Level Dependent (Gold) Technique, will eventually be good enough to be used internationally.
Strokes occur when the blood supply to the brain is disturbed, usually by a blockage.
The Gold technique works by giving patients an MRI scan while they are inhaling oxygen through a mask.
By watching what happens to the oxygen in the brain on the scan, the specialists can see how much of the brain tissue has already died and how much of the surrounding area is dying but still recoverable. This area of tissue that could potentially be saved is known as the penumbra. Sufficient penumbra means the patient could benefit from a clot-busting treatment.
Dr Santosh said: "Research shows that the penumbra can stay viable up to 48 hours after a stroke so it gives us more valuable time to treat the patient."
In order to ensure as much as possible of the oxygen inhaled by the patient is carried to the brain during the scan, the researchers are proposing to inject patients with perflourocarbon – a compound known for its ability to hold oxygen.
Perflourocarbons are tiny – much smaller than a red blood cell – so they can potentially carry oxygen to the brain through very small channels, evading blockages.
Dr Santosh said using the perflourocarbons not only meant scanning for the penumbra could be done more swiftly and efficiently, it also helped mitigate the problem of oxygen deprivation in the brain.
In rat models studied by his team, the impact of a stroke was found to be reduced by half when using the Gold technique.
Dr Santosh and his colleagues, who are working in collaboration with staff at Glasgow University, are hoping to start the first human trials towards the end of next year.
He said: "People are incapacitated after strokes by weakness and their inability to move. Even a small amount of movement can give people greater independence.
"It is also surprising sometimes how strokes affect language and the ability to understand.
"On both grounds we would like to think we might be able to make a big difference."
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