‘Rerouting’ Mind Blood Circulate: Previous Approach Might Be New Advance In opposition to Strokes
By Amy Norton HealthDay Reporter
WEDNESDAY, March 3, 2021 (HealthDay Information)
Medical doctors are testing a decades-old surgical method as a brand new strategy to deal with sure stroke sufferers. And the preliminary outcomes look promising, they are saying.
At subject are strokes attributable to intracranial atherosclerosis, the place blood vessels throughout the mind grow to be hardened and narrowed.
Strokes happen when the blood provide to the mind is disrupted, depriving tissue of oxygen and vitamins. There may be varied causes, and intracranial atherosclerosis is behind an estimated 10% to fifteen% of strokes in the USA, in accordance with research creator Dr. Nestor Gonzalez, a professor of neurosurgery at Cedars-Sinai Medical Heart in Los Angeles.
The outlook after these strokes, he stated, is poorer in comparison with strokes with different causes, akin to blockages within the neck’s carotid arteries.
Proper now, sufferers are normally handled with medicines — together with blood thinners and hypertension medication — to attempt to thwart a repeat stroke.
And whereas that does assist, the recurrence price remains to be excessive, Gonzalez stated.
Surgical approaches have been tried — together with putting stents in blocked mind arteries, just like what’s generally achieved for narrowed coronary heart arteries.
But it surely simply would not work as nicely within the mind, stated Dr. Louis Kim, chief of neurological surgical procedure at Harborview Medical Heart in Seattle.
Intracranial atherosclerosis is troublesome to deal with, Kim defined, as a result of artery-clogging “plaques” could also be scattered throughout the mind.
So Gonzalez and his colleagues have been learning a unique method — a surgical method by the tongue-twister title of encephaloduroarteriosynangiosis (or EDAS, for brief).
EDAS has been used for many years to deal with a uncommon syndrome referred to as Moyamoya illness, the place blood vessels on the base of the cranium progressively slender and restrict blood movement to the mind.
As neurosurgery goes, the method is pretty easy and minimally invasive: a piece of an artery within the scalp is re-routed to the floor of the mind. Over the subsequent few weeks, new blood vessels start to department out from that artery into the mind, Gonzalez defined.
The concept is to provide higher blood movement to areas of mind tissue liable to stroke.
In a preliminary research of 28 sufferers handled with EDAS, Gonzalez and his workforce discovered that three — just below 11% — had one other stroke within the subsequent two years.
For comparability, they level to a scientific trial the place sufferers with strokes attributable to intracranial atherosclerosis had been handled with customary medicines. Their stroke recurrence price was 37%.
Whereas that may be a substantial distinction, there are large caveats, in accordance with Kim, who was not concerned within the research.
Comparisons between two totally different research aren’t dependable proof of effectiveness, he stated. What’s wanted is a scientific trial during which sufferers are randomly assigned to obtain both customary care or customary care plus surgical procedure.
Gonzalez agreed, and stated that’s precisely what’s within the works: a bigger trial at a number of U.S. medical facilities funded by the Nationwide Institutes of Well being. Sufferers will both obtain the “greatest customary medical administration,” or those self same medicines plus EDAS.
Kim stated that whereas the present outcomes are “pilot information,” the concept of testing EDAS for these stroke sufferers is a sound one.
“That is an thrilling strategy to basically recycle a widely known neurological process,” he stated.
EDAS, Kim stated, is a “easy” surgical procedure, and because it has been round for a very long time, docs know deal about its security.
“The operation is low-risk,” Kim stated. A foremost subject, he famous, is that it doesn’t at all times work nicely.
“In some circumstances, the brand new blood vessel development is lackluster,” Kim stated.
If including EDAS to treatment does show to stop extra strokes, it might solely be an possibility for a minority of stroke sufferers.
Gonzalez famous, although, that intracranial atherosclerosis appears to disproportionately have an effect on Black, Hispanic and Asian People. It might trigger nearer to twenty% of strokes in these teams.
The research was printed in a current subject of the journal Neurosurgery.
The American Stroke Affiliation has extra on stopping repeat strokes.
SOURCES: Nestor Gonzalez, MD, professor, neurosurgery, and director, Neurovascular Laboratory, Cedars-Sinai Medical Heart, Los Angeles; Louis Kim, MD, MBA, chief, neurological surgical procedure, Harborview Medical Heart, Seattle, and professor, neurological surgical procedure, College of Washington Faculty of Drugs, Seattle; Neurosurgery, Jan. 19, 2021, on-line
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