Medical Experts From Yale, UConn Present Stroke Research

WALLINGFORD — As the American Heart Association/American Stroke Association celebrate American Heart Month in February, the organization is issuing a reminder that many heart disease risk factors are also risk factors for stroke. Leading experts from around the world who hope to increase awareness about stroke gathered last week during the International Stroke Conference in San Diego, Calif.

Among those presenting their latest research and clinical advances were Connecticut residents Judith Lichtman, PhD, Murat Gunel, MD, and Karin Nystrom, MSN, from the Yale School of Medicine, and Louise D McCullough, MD, PhD, from the University of Connecticut Medical Center.

Stroke is the third-leading cause of death in Connecticut and across the country, and the number one cause of long-term disability. The most common type of stroke, called an ischemic stroke, occurs when a blood vessel in the brain becomes clogged.

The most promising treatment for ischemic stroke is an FDA-approved clot-busting drug called tPA, which must be administered within three hours from the onset of symptoms to work best. Symptoms can include severe headache, blurred vision, slurred speech, trouble walking, and sudden confusion.

Dr Lichtman, associate professor and researcher at Yale University, found that fewer elderly women are readmitted to the hospital for stroke or heart disease during the month or during the year following a transient ischemic attack (TIA) compared to elderly men.

Dr Lichtman and her team reviewed the administrative records of more than 122,000 patients, 65 or older, hospitalized with a TIA in 2002. Follow-up showed a better prognosis for women. Fewer women were subsequently readmitted for stroke or coronary artery disease and women had lower mortality rates than men, even after accounting for demographics, medical history and coexisting conditions. Women did, however, have slightly higher rates of rehospitalization for TIA over one year.

Additional research is needed to explain these gender-associated differences. A TIA is a “warning stroke” or “ministroke” that produces strokelike symptoms but no lasting damage. Recognizing and treating TIAs can reduce the risk of a major stroke. The usual TIA symptoms are the same as those of stroke, only temporary. The short duration of these symptoms and lack of permanent brain injury is the main difference between TIA and stroke.

Dr Louise McCullough, a vascular neurologist and neuroscientist, examined the records of female stroke patients at Hartford Hospital, and discovered that women generally took more time getting to the hospital after having a stroke, which greatly decreased the available time to administer tPA. Dr McCullough and her team found several reasons that may explain the delay, including the fact that more women then men live alone and many women do not realize they are having a stroke because they are unaware of stroke risks and symptoms.

Women were also more likely to have permanent disability compared to men of the same age. Dr McCullough said, “Many women with heart disease do not realize that it increases their risk for stroke. It is important that we educate women about the risks, warning signs, and symptoms of stroke so they can get to the hospital in time to receive tPA.”

Dr Murat Gunel, chief of Yale Neurovascular Surgery Program and co-director of Yale Program on Neurogenetics, has discovered potential genetic markers for brain aneurysms, which are bubble or balloonlike dilations of brain blood vessels. These aneurysms can then rupture, causing bleeding strokes. Strokes resulting from aneurysms are rarer, but more dangerous and typically require more invasive treatments than ischemic strokes. 

In his study, Dr Gunel examined the genome of aneurysm patients and isolated a pattern that could indicate increased risk for ruptured aneurysms. These findings, which provide a new insight into brain aneurysms, could lead to the development of new screening tests to identify patients at risk for this type of stroke, and preventive therapy to strengthen blood vessels before they burst.

Dr Gunel said, “Even though we have made significant strides in treating unruptured aneurysms, until now we have not had an effective means of identifying the majority of individuals at risk of developing this deadly problem. These genetic findings provide a starting point for changing that equation.”

Yale-New Haven Hospital and Lawrence & Memorial Hospital in New London recently launched Connecticut’s first TeleStroke program. This program, spearheaded by Karin Nystrom of Yale, uses a HUB and SPOKE model that enables physicians at Lawrence & Memorial to communicate with stroke experts at Yale-New Haven. When a patient at Lawrence & Memorial is diagnosed with an acute stroke, doctors can connect with Yale-New Haven via video conference in less than five minutes.

“We utilize a high-speed network videoconferencing and image-sharing technology to rapidly assess and consult with our partners at Lawrence & Memorial on treatment options for acute stroke victims,” said Ms Nystrom, clinical coordinator of Yale’s stroke program. “Doctors can connect with Lawrence & Memorial’s emergency department and are virtually at the patients’ bedside with access to medical records and CT scan images.”

The program has been operating full time since October and averages one to two consults per week. Implementing the TeleStroke program required the help and cooperation and collaboration of many different departments at both hospitals. In total, it took six months from inception until the first live consultation.

The Connecticut Department of Public Health is currently studying this network, and hopes to implement a similar program statewide in the near future.

All four researchers presented their findings at the International Stroke Conference on Thursday, February 19.