National Institutes of Health Looks at Strokes; Studies How to Prevent Them as well as Follow-up Care

Stroke is the fourth leading cause of death among Americans. Hospitalization and medical care immediately following a stroke are very costly, as is the rehabilitative care. So the question is how best to prevent a stoke or to help patients recover following a stroke.

The National Institutes of Health is conducting ongoing studies to determine ways of preventing strokes. Some of the most recent studies include:

— The use of dilation and stenting techniques similar to those used to unclog and open heart arteries has been proposed as a less invasive alternative to carotid surgery to remove the buildup of plaque within the carotid artery, which supplies blood to the head and neck. According to the NIH, carotid endarterectomy is considered the best treatment for preventing stroke and other vascular events. Stenting is a newer, less invasive procedure in which an expandable metal stent is inserted into the carotid artery to keep it open after it has been widened with balloon dilation. But the new NIH study found that the safety and effectiveness of the two procedures was largely the same. Following this study, doctors will have more options to tailor treatments for people considered at risk for stroke.

— Another study found that walking on a treadmill — both in a supervised rehabilitative environment and on a home device — helped stroke survivors improve their walking. Only 37 percent of stroke survivors are able to walk after the first week following their stroke. The study compared a home exercise program managed by a physical therapist, aimed at enhancing patients’ flexibility, range of motion, strength and balance as a way to improve their walking. This study found that stroke patients who had physical therapy at home improved their ability to walk as well as those who were treated in a training program that requires the use of a treadmill device followed by walking practice. In addition, the study also found that patients continued to improve up to one year after stroke. This defied conventional wisdom that recovery occurs early and tops out at six months.

— In a third study, investigators looked at new approaches to stroke prevention for people with a history of small subcortical strokes. The trial was designed to compare: 1) aspirin alone vs. combined antiplatelet therapy (aspirin and clopidogrel), and 2) intensive vs. standard blood pressure control. Subcortical strokes, also called lacunar strokes, occur when the thread-like arteries within cerebral tissue become blocked and halt blood flow to the brain. They account for up to one-fifth of all strokes in the U.S. and are especially common among people of Hispanic descent. Researchers found that the combined antiplatelet therapy was about equal to aspirin in reducing stroke risk, but it almost doubled the risk of gastrointestinal bleeding.

— A fourth study set out to compare the safety and effectiveness of aggressive medical treatment (i.e., intensive management of key stroke risk factors including blood pressure, cholesterol, and lifestyle modification) alone to aggressive medical therapy plus a Food and Drug Administration-approved intracranial stent to prevent another stroke in people who had already suffered a stroke. The results of this trial showed that the group that received the intensive medical management alone had better outcomes than the group who also received the stent. This study provides an answer to a long-standing question by physicians–what to do to prevent a devastating second stroke in a high risk population.

Kreisman Law Offices has been handling medical malpractice cases for more than 36 years for individuals and families in and around Chicago, Cook County, and surrounding areas, including Wheaton, West Chicago, Inverness, Des Plaines, Skokie, and Bolingbrook.