Short Duration Hypothermia To Prevent Subsequent Intracranial Pressure Rise.
Funder
National Health and Medical Research Council
Funding Amount
$436,453.00
Summary
Elevated brain pressure after stroke or other forms of brain injury can cause further injury and death. Body cooling to 32-33 C (hypothermia) for 12-24 hours saves lives after some forms of brain injury, but may have major side effects. We found that 2 hours hypothermia has a long-lasting effect preventing pressure elevation. We will determine the best temperature and duration of hypothermia in a stroke model and use imaging to confirm findings in patients, with a view to later human trials.
A New Paradigm To Prevent Intracranial Hypertension
Funder
National Health and Medical Research Council
Funding Amount
$408,388.00
Summary
Increasing brain pressure after stroke or other forms of brain injury can cause further injury and death. Body cooling by 4-5 0C (hypothermia) for 12-24 hours saves lives after some forms of brain injury, but may have major side effects. We found that 2 hour hypothermia has a long-lasting effect preventing pressure elevation. We will determine the best temperature and duration of hypothermia in a stroke model and use imaging to confirm findings in patients, with a view to later human trials.
Acute Stroke: Imaging The Ischaemic Penumbra With Perfusion CT
Funder
National Health and Medical Research Council
Funding Amount
$243,000.00
Summary
The burden of stroke is large. Clot-dissolving medication (thrombolysis) may dramatically improve the outcome of many patients with severe stroke by unblocking the affected brain artery. However, very few patients receive this medication, as the current approval is restricted to treatment within 3 hours of stroke onset. The major aim of thrombolysis is to rescue brain tissue with reduced blood flow (the ischaemic penumbra) from becoming irreversibly damaged (infarcted). The penumbra progressivel ....The burden of stroke is large. Clot-dissolving medication (thrombolysis) may dramatically improve the outcome of many patients with severe stroke by unblocking the affected brain artery. However, very few patients receive this medication, as the current approval is restricted to treatment within 3 hours of stroke onset. The major aim of thrombolysis is to rescue brain tissue with reduced blood flow (the ischaemic penumbra) from becoming irreversibly damaged (infarcted). The penumbra progressively becomes infarcted over the next 48 hours if blood flow is not restored by the blood clot in the brain artery being dissolved. Penumbral brain tissue cannot be identified with clinical assessment or standard CT scanning. New generation CT scanners are capable of assessing brain blood flow. Perfusion CT imaging (CTP) is well tolerated and time-efficient, and can be integrated into the brain CT scanning process performed on all stroke patients. Preliminary evidence suggests that CTP can distinguish between tissue that represents the ischaemic penumbra, and tissue that is already permanently injured. This project aims to validate the use of CTP in imaging the ischaemic penumbra. This will be based on testing the accuracy of CTP tissue signatures of the penumbra in predicting clinical outcome and final stroke size. This is the only national collaborative study planned worldwide for this relatively new but increasingly accessible imaging technique. The ability to rapidly identify under-perfused but still viable brain with CTP would add new and exciting management options to the routine emergency assessment of stroke patients. The results of this unique study could have a significant impact on the management of acute stroke worldwide. If validated, it is anticipated that CTP would be widely used to improve patient selection for stroke thrombolysis, especially in safely extending the time window so that a greater number of patients can be treated with better outcomes.Read moreRead less
Discovery To Therapy Implementation In Acute Stroke
Funder
National Health and Medical Research Council
Funding Amount
$585,269.00
Summary
Advances in acute stroke therapies are occurring rapidly but challenges remain in their safe and effective delivery to stroke sufferers. This research focuses on testing a potentially superior ‘clot busting’ drug therapy for acute stroke and on identifying reasons why one of the most widely used current therapies carries a risk of significant harm due to bleeding into the brain. The work also investigates how to better implement the newest form of acute therapy, mechanical blood clot extraction.
Tenecteplase Versus Alteplase For Stroke Thrombolysis Evaluation (TASTE) Trial
Funder
National Health and Medical Research Council
Funding Amount
$4,180,030.00
Summary
Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation (TASTE) is an Australian-led international randomised trial designed to generate practice-changing evidence by translating the advanced imaging treatment selection approach used in our previous pilot studies. TASTE aims to confirm the superiority of the new-generation clot-dissolving agent, tenecteplase, over the standard agent, alteplase, in the broad group of stroke patients eligible for acute clot-dissolving treatment.
Implementation Of Quality Use Of Advanced CT Imaging In Acute Stroke
Funder
National Health and Medical Research Council
Funding Amount
$1,128,594.00
Summary
Many centres now use advanced CT scanning techniques to assess stroke patient suitability for clot-dissolving treatment. However, there is major variation across Australia in the clinical application of advanced CT scanning techniques, which is a barrier to the delivery of this treatment. This project addresses the variation in CT imaging techniques by developing, piloting and evaluating the implementation of a standardised advanced CT scanning strategy for acute stroke patients.
Characterising A Newly Identified Mechanism Causing Elevation Of Intracranial Pressure After Acute Neurological Injury
Funder
National Health and Medical Research Council
Funding Amount
$510,905.00
Summary
Our group discovered that increased pressure on the brain (intracranial pressure – ICP) may be more common and important than has been recognised following stroke, and potentially other brain disorders. We also identified a simple potential therapy, short-duration body cooling, which completely prevents the pressure rise. In this project we will characterise the ICP rise, identify its molecular trigger and determine the best method of body cooling tor use in clinical trials in stroke patients.
A New Understanding Of Stroke Pathophysiology: Late Infarct Expansion May Be Under-recognised And Easily Preventable.
Funder
National Health and Medical Research Council
Funding Amount
$411,496.00
Summary
Stroke caused by a blood clot blocking a brain artery is one of the leading causes of death and disability. We recently discovered that pressure in the skull rises 24 h after stroke. Increasing evidence suggests that this causes growth of the stroke through its effects on brain blood flow. We will measure the blood flow reduction caused by the pressure rise and how frequent it is, then determine how much brain is saved and disability prevented by blocking it.
New Therapies For Stroke – Preventing Stroke Progression And Enhancing Recovery
Funder
National Health and Medical Research Council
Funding Amount
$463,652.00
Summary
Stroke is a major cause of death and disability worldwide. Dr Spratt’s team have discovered a new mechanism causing pressure to rise in the skull after stroke. They will build on their discovery of a promising new therapy to prevent early worsening of stroke and improve patient outcomes. He also leads a team studying better stroke recovery by promoting activity by enriching the rehabilitation environment, and ways to improve fitness in stroke survivors.