1
|
Maniskas ME, Roberts JM, Gorman A, Bix GJ, Fraser JF. Intra-arterial combination therapy for experimental acute ischemic stroke. Clin Transl Sci 2021; 15:279-286. [PMID: 34463026 PMCID: PMC8742650 DOI: 10.1111/cts.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/14/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022] Open
Abstract
Acute ischemic stroke continues to devastate millions of individuals worldwide. Current treatments work to restore blood flow but not rescue affected tissue. Our goal was to develop a combination of neuroprotective agents administered intra-arterially following recanalization to target ischemic tissue. Using C57Bl/6J male mice, we performed tandem transient ipsilateral middle cerebral/common carotid artery occlusion, followed by immediate intra-arterial pharmacotherapy administration through a standardized protocol. Two pharmacotherapy agents, verapamil and lubeluzole, were selected based on their potential to modulate different aspects of the ischemic cascade; verapamil, a calcium channel blocker, works in an acute fashion blocking L-type calcium channels, whereas lubeluzole, an N-methyl-D-aspartate modulator, works in a delayed fashion blocking intracellular glutamate trafficking. We hypothesized that combination therapy would provide complimentary and potentially synergistic benefit treating brain tissue undergoing various stages of injury. Physiological measurements for heart rate and pulse distention (blood pressure) demonstrated no detrimental effects between groups, suggesting that the combination drug administration is safe. Tissue analysis demonstrated a significant difference between combination and control (saline) groups in infarct volume, neuronal health, and astrogliosis. Although a significant difference in functional outcome was not observed, we did note that the combination treatment group had a greater percent change from baseline in forced motor movement as compared with controls. This study demonstrates the safety and feasibility of intra-arterial combination therapy following successful recanalization and warrants further study.
Collapse
Affiliation(s)
- Michael E Maniskas
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA.,Department of Neurology, University of Kentucky, Lexington, Kentucky, USA.,Department of Radiology, University of Kentucky, Lexington, Kentucky, USA.,Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA.,Sanders Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA.,Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, Kentucky, USA
| | - Jill M Roberts
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA.,Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Amanda Gorman
- Sanders Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA.,Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, Kentucky, USA
| | - Gregory J Bix
- Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Justin F Fraser
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA.,Department of Neurology, University of Kentucky, Lexington, Kentucky, USA.,Department of Radiology, University of Kentucky, Lexington, Kentucky, USA.,Department of Neuroscience, University of Kentucky, Lexington, Kentucky, USA.,Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
2
|
Le SM, Copeland LA, Zeber JE, Benge JF, Allen L, Cho J, Liao IC, Rasmussen J. Factors affecting time between symptom onset and emergency department arrival in stroke patients. eNeurologicalSci 2020; 21:100285. [PMID: 33204859 PMCID: PMC7649365 DOI: 10.1016/j.ensci.2020.100285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/21/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background and purpose Delays in seeking care compromise diagnosis, treatment options, and outcomes in ischemic strokes. This study identified factors associated with time between stroke symptom onset and emergency department (ED) arrival at a private nonprofit medical center serving a large rural catchment area in central Texas, with the goal of identifying symptomatic, demographic, and historical factors that might influence seeking care. Methods Demographic and clinical data from a large tertiary care center's Get With The Guidelines (GWTG) database were evaluated in 1874 patients presenting to the ED with a diagnosis of transient ischemic attack (TIA), intracranial hemorrhage, subarachnoid hemorrhage, or ischemic stroke. The dependent variable was time between discovery of stroke symptoms and presentation at the hospital (time-to-ED). Factors entered into regression models predicting time-to-ED within 4 h or categorical time-to-ED. Results The average time from symptom onset to presentation was 15.0 h (sd = 23.2), with 43.6% of the sample presenting within 4 h of symptom onset. Results suggested that female gender (Odds Ratio [OR] = 0.70; 95% Confidence Interval [CI] 0.23–0.74), drug abuse (OR = 0.41; CI 0.23–0.74), and diabetes were significantly associated with longer time to presentation. Conclusions A combination of demographics, stroke severity, timing, and health history contributes to delays in presenting for treatment for ischemic stroke. Stroke education concentrating on symptom recognition may benefit from a special focus on high-risk individuals as highlighted in this study. Patients that had stroke symptoms occurring during the daytime were more likely to present within 4h of symptom onset. Females and younger patients were more likely to arrive after 4h of symptom onset. Comorbid conditions such as diabetes and substance abuse were associated with delayed presentation times. Other comorbid conditions such as hypertension or dyslipidemia were not associated with decreased time of presentation.
Collapse
Affiliation(s)
- Scott M Le
- Duke Health, Department of Neurology, Division of Vascular Neurology and Stroke, 40 Duke Medicine, Circle, Durham, NC 27710, United States of America.,Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Texas A&M Health Science Center College of Medicine, 8447 Bryan Rd, Bryan, TX 77807, United States of America
| | - Laurel A Copeland
- VA Central Western Massachusetts, 421 N Main St, Leeds, MA 01053, United States of America.,University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, 55 N Lake Ave, Worcester, MA 01655, United States of America
| | - John E Zeber
- University of Massachusetts at Amherst, School of Public Health & Health Sciences, Health Policy & Management, 300 Massachusetts Ave, Amherst, MA 01003, United States of America
| | - Jared F Benge
- Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Texas A&M Health Science Center College of Medicine, 8447 Bryan Rd, Bryan, TX 77807, United States of America
| | - Leigh Allen
- Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Ascension Seton, 1201 West 38 St, Austin, TX 78705, United States of America
| | - Jinmyoung Cho
- Baylor Scott & White Health, Center for Applied Health Research, 4236 Lowes Dr., Temple, TX 76502, United States of America
| | - I-Chia Liao
- Baylor Scott & White Health, Center for Applied Health Research, 4236 Lowes Dr., Temple, TX 76502, United States of America
| | - Jennifer Rasmussen
- Baylor Scott & White Health, Department of Neurology, 2401 S 31 Street, Temple, TX 76508, United States of America.,Texas A&M Health Science Center College of Medicine, 8447 Bryan Rd, Bryan, TX 77807, United States of America
| |
Collapse
|