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Strokes may be stopped by new procedure in neuroradiology

By Daily Bruin Staff

Feb. 13, 1997 9:00 p.m.

Friday, February 14, 1997

TECHNIQUE:

Neuroperfusion therapy may prove to be useful to battle third
biggest killerBy Kathryn Combs

Daily Bruin Contributor

Stroke, the third leading cause of death in the United States,
claims over 500,000 lives each year and is the leading cause of
disability.

In the desperate search for an effective and standard treatment
for stroke, a group of UCLA physicians, led by Dr. John Frazee, are
currently conducting a Food and Drug Administration (FDA) clinical
trial on what they call "back door" therapy.

The name of this newly discovered therapy is Neuroperfusion.

A stroke occurs when the brain is deprived of its vital blood
supply due to a blockage in the arteries. As a result, this part of
the brain dies, and the patient loses the ability to perform
functions associated with the damaged part of the brain.

According to Frazee, stroke has been considered an untreatable
affliction until a year ago, when the drug tissue plasminogen
activator (tPA) was approved for clinical use by the FDA.

tPA is a drug that, when administered intravenously, clears
blockages in the arteries that may be causing the stroke. However,
according to Frazee, this therapy is not perfect.

"This drug must be used within the first three hours (and)
that’s hard to do because the population of patients and physicians
are still poorly educated," said Frazee.

Explaining that it is difficult for both doctors and members of
the general population to recognize symptoms of stroke, he also
added that many people still think that stroke is untreatable.

"The other issue with TPA is that it’s like Drano … it takes a
period of time to dissolve the blood clot," said Frazee.
"(However), the tissue beyond, which isn’t getting the oxygen and
glucose that it needs, may continue to die."

Until recently, stroke wasn’t considered to be a medical
emergency. However, Frazee stressed that UCLA has always been at
the forefront of stroke research and education for at-risk
groups.

"Up until last year, there was basically very little in the way
of treatment for stroke," said Frazee. "(However) we now have a
procedure at UCLA, and only at UCLA, for treating acute stroke
patients."

Frazee’s research team is conducting an ongoing clinical trial
examining the viability and efficacy of Neuroperfusion.

During this procedure, oxygenated blood is withdrawn from an
artery located in the groin and pumped into catheters located in
the patient’s neck. Arterial blood, rich in oxygen, is then
supplied directly to the brain tissue through the veins, normally
used to drain fluids away from the brain.

According to Frazee, the advantage of this procedure is that the
brain is immediately supplied with the oxygenated blood it needs to
survive, so the tissues being starved can be resuscitated. As a
result the trauma area of the brain will not die.

According to Frazee, another advantage of this procedure is that
it can be performed up to seven hours after the initial onset of
stroke.

Dr. Gary Duckwiler, an associate professor of radiological
sciences at UCLA, has actually performed neuroperfusion.

"When I initially performed the first procedure, it was a
complex technical process," said Duckwiler.

"(But) after about ten minutes of the neuroperfusion, the
patient was dramatically improved," he added.

Dr. Pierre Gobin, co-director of the UCLA Stroke Center
Interventional Neuroradiology Program, said that he was initially
skeptical about this procedure, but consequent experimental work
convinced him of its viability.

"When I first heard of this, I thought it was crazy," he
said.

"To reverse the direction of blood, especially in an organ such
as the brain, … that’s just amazing." he added.

When the actual trial ends, Neuroperfusion will have been
performed on 10 patients at UCLA. So far, six patients have
undergone this revolutionary procedure, and of these, four have
almost fully recovered.

"We spend 30 billion dollars a year on rehabilitation for people
suffering from stroke. This has a substantial financial impact on
the health care system."

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