Diagnostic Imaging Online
November
2, 2000
Interventional
stroke registry hopes to set up emergency treatment protocols
In an effort
to standardize emergency stroke treatment for patients across the U.S.,
an interventional stroke therapy outcomes registry has been created to
chart intra-arterial thrombolysis.
Only about
a hundred institutions practice emergency stroke therapy and even their
protocols vary widely, said registry creator Dr. John J. "Buddy" Connors,
director of interventional neuroradiology at Inova Fairfax Hospital in
Fairfax, VA. The Interventional Stroke Therapy Outcomes Registry (INSTOR)
will help determine the best drugs, devices, and techniques for acute
stroke treatment.
In an effort
to make the data more statistically relevant, Connors hopes physicians
will choose among five or six protocols, especially concerning dosage.
"I am not
telling physicians what to do; they must do what is best for their patients.
I just want to collect and analyze the data and show positive outcomes
for specific protocols," he said.
Eventually,
such standardization may make it easier for communities to set up stroke
centers, much like today's heart centers, according to Connors and his
supporters.
"Stroke
is a treatable disease," said Dr. Rodney Raabe, director of radiology
at Sacred Heart Medical Center in Spokane, WA. "The information collected
for this registry will help us prove to everybody that there are outcomes
that stroke victims do better."
Other clinicians
knowledgeable in stroke therapy options question the pace at which Connors
wants to advance therapies that may not have been scientifically proven.
"We know
it's important to do something quickly for stroke patients, but do we
really know for which patients it is better to drive by two hospitals
that can provide IV therapy just to get to one that can do IA therapy
thirty minutes farther away?" asked Judith Spilker, a cerebrovascular
research coordinator in the department of emergency medicine at the University
of Cincinnati.
The Society
of Cardiovascular and Interventional Radiology (SCVIR) and the American
Society of Interventional and Therapeutic Neuroradiology (ASITN) consider
intra-arterial thrombolytic therapy to be acceptable and appropriate for
acute stroke, and ongoing research will better define the parameters of
such intervention, Connors said.
"We know
that if we open up a blood vessel quickly enough we can save the brain.
It would be inappropriate for us not to try and save those we can," he
said.
Stroke
therapy is essentially nonexistent in the U.S., according to Connors.
Fewer than 2% of patients receive acute treatment and fewer than one-half
of 1% are helped by any therapy at all.
"The rest
are doomed by their stroke to whatever fate they have been given. We have
to do what we can to improve those statistics," he said.
One reason
Connors is setting up this registry is because no pharmaceutical companies
are willing to invest the money needed for efficacy trials. Billions of
dollars have already been spent on acute stroke therapies, including IV
tPA (tissue plasminogen activator), neuroprotective agents, anticoagulants,
and antiplatelets. Because IA therapy uses only 1% of the tPA that IV
therapy uses, drug companies do not see a big enough return on investment
to perform studies, he said.
"This is
a lot of hard work and there's a lot of enthusiasm for the registry. But
there is no money. I feel like a general who's been given a battleship
but no crew."
Right now,
INSTOR's Web site is a work-in-progress.
Connors expects it to be up and running within a month. Among other items,
it will contain the form for physicians to provide stroke protocol data.
--By C.P.
Kaiser
For
additional information on stroke imaging from the DI archives:
