Leading Neurologist Gives Insight on Stroke Care Innovation
SAN FRANCISCO – Every second counts in detecting and treating stroke, the leading cause of serious, long-term disability in the U.S. Each year, approximately 795,000 people suffer a stroke. New research at Sutter Health is helping bring faster, life-changing care to stroke patients through a clinical trial called BEST-MSU that will test the efficacy of Sutter’s Mobile Stroke Unit (MSU).
In March, Sutter stroke researchers and members of the MSU team, including Nobl Barazangi, MD, PhD, Ilana Spokoyny, MD, and Joey English, MD, PhD enrolled the first patient into BEST-MSU. The study will compare outcomes in acute ischemic stroke (AIS) patients pre-treated in the MSU versus comparable patients having “standard” pre-hospital management.
To kick off Stroke Awareness Month, we interviewed Dr. Barazangi, Deputy Medical Director of Clinical Informatics, Neuroscience Service Line, Sutter Health Bay Area, about her perspectives on the latest innovations in stroke research and clinical trials at Sutter.
1. What are the most pressing challenges in managing stroke today, despite recent advances in treatment?
A ‘clot-busting’ drug called recombinant tissue plasminogen activator (rtPA) has significantly advanced our ability to treat AIS, which occurs when a vessel supplying blood to the brain is obstructed. AIS accounts for about 87 percent of all strokes, with the rest being of the hemorrhagic type.
Similarly, the use of mechanical treatments like stent retrievers to remove a clot have been game-changers in improving AIS treatment. Despite these advances in treatment, we still face the challenge of reaching patients at the right time and place, especially when they live in rural or remote locations. Community engagement and education on stroke awareness (signs and symptoms) also continue to be an ongoing part of our work in stroke advocacy.
We’re fortunate to have comprehensive data from many completed clinical trials to guide our treatment decisions for patients with AIS. But for patients with intracerebral or hemorrhagic stroke, there remains the opportunity for new, proven, evidence-based treatments to recommend.
- What are you most excited about when we look to new advances in diagnosis and treatment on the horizon?
I’m tremendously proud of Sutter’s Mobile Stroke Unit (MSU). And with the BEST-MSU clinical trial, for the first time in the U.S. we have an opportunity to examine the safety and feasibility of treating patients on MSUs through a national, multi-site study. Approximately 1,000 eligible patients will be enrolled in the trial in the San Mateo County area and at other participating study sites in in Memphis, New York, Denver, Indiana, and Los Angeles.
With the Sutter MSU being the first and only MSU in Northern California and the only community hospital participating in the BEST-MSU trial, our team is helping pioneer the future of acute stroke care that incorporates advanced out-of-hospital approaches to triage.
And it’s also exciting to envision a time in the near future where we can customize treatment for patients based on their CT scan, which provides us a picture of brain areas impacted by stroke.
- How are investigators at Sutter applying the latest insights in research to develop new ways to diagnose and treat stroke?
Care providers and researchers at Sutter work in multi-disciplinary teams. And the more we integrate and collaborate, the more precisely we can diagnose and treat health concerns as complex as stroke. These collaborations create ‘communities of interest’ within Sutter to advance our work. Through clinical trials, we also have an opportunity to become early adopters of new approaches, and to interact and learn from peers across the U.S.
- What current or upcoming stroke initiatives
at Sutter are you most intrigued by? Why?
We are in the process of building a database to house all the quality data from our stroke centers across the system. Historically, we have collected this data and reported it to the American Heart Association, as part of our stroke center certification. The data was siloed and we didn’t have the ability to easily compare across sites. Soon, with the Sutter Stroke database, we will be able to compare processes and patient outcomes to improve stroke care across the system. This will provide us with powerful data for future studies.
We’ve partnered with a third-party analytics company, Biome Analytics, to integrate detailed stroke clinical data with the corresponding administrative data to understand operational and financial impact of our clinical practices, and variation in how we treat stroke patients at Sutter. We anticipate this partnership will provide us insights into how best to diagnose, treat, and triage patients in ways that are both safe and cost-effective.
- What sparked
your latest “ah ha” moments in your own research
We know that patients with health concerns affecting blood vessels in the brain or spine are impacted by biological mechanisms that also impact patients with cardiovascular diseases. I think there are new opportunities for multidisciplinary collaboration at Sutter Health in these areas. A first step might be to study patients with atrial fibrillation, or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications.
I’m intrigued by the idea of designing clinical trials that would test and compare approaches to actually prevent stroke from occurring in the first place. I’m excited by the opportunity to use the Sutter Stroke Database and integration of Sutter’s service lines to study atrial fibrillation.
1. Centers for Disease Control and Prevention (https://www.cdc.gov/stroke/facts.htm).
Stay tuned for additional perspectives on Sutter stroke research from Manoj Mittal, MD, Medical Director, Stroke Neurocritical Care, Sutter Health Valley Area, later this month.
Curious to learn about other advances in research at Sutter Health? Stay up to date with Sutter research news.