Posts Tagged 'Swedish Stroke Program'

Hugh Markus – 2011 Merrill P. Spencer Lecturer

 

Hugh Markus, B.M., B.Ch., D.M., FRCP
Featured Presenter: 6th Annual Merrill P. Spencer, M.D. Endowed Lecture

 

Each spring, The Merrill P. Spencer, M.D. Endowed Lecture is presented in conjunction with the annual Swedish Neuroscience Institute Cerebrovascular Symposium. This year, we are pleased to welcome Dr. Hugh Markus, Professor of Neurology at St. George’s University of London.

Hugh Markus was educated in Medicine at Cambridge and Oxford Universities and then carried out medical jobs in Oxford, London and Nottingham before training in neurology in London. He was senior lecturer and subsequently, reader in neurology at Kings College London before moving to the chair of neurology at St George’s in 2000.

His clinical interests are in stroke, and he is clinical lead for stroke at St George’s Hospital. He is involved in both acute stroke care and outpatient stroke clinics, and runs specialist services for patients with sub cortical vascular disease and genetic forms of stroke.

His research interests are in applying molecular genetic and imaging techniques to investigate the pathogenesis of stroke. Genetic studies are primarily trying to identify genetic causes of sporadic stroke and he is the principal investigator for the Wellcome Trust Case Control Consortium 2 Ischemic Stroke Study, which is performing a large genome-wide association study in ischemic stroke. The imaging techniques he uses are Transcranial Doppler emboli detection and MRI.

His postdoctoral thesis was on emboli detection, which involved experimental studies validating the technique and early clinical studies applying it to patients with a variety of potential embolic sources. He has carried out a number of studies showing that embolic signals predict stroke in carotid artery stenosis, and pioneered the use of the technique to evaluate anti-platelet therapies. He was also principal investigator for the CARESS study. Recently, he finished the Asymptomatic Carotid Emboli Study (ACES) which demonstrated that embolic signals predict risk in asymptomatic carotid stenosis.

The first international conference which Dr. Markus attended was a Transcranial Doppler ultrasound workshop organized by Merrill Spencer, M.D. in the early 1990s.

To register for the 5th Annual Cerebrovascular Symposium: New Therapeutics for Today’s Patient on May 12-13, visit www.swedish.org/cvdregister. Registration for the conference includes the Merrill P. Spencer, M.D. Endowed Lecture.

To attend only the reception and Merrill P. Spencer, M.D. Endowed Lecture on May 12: www.swedish.org/cvdspencer. This is a free CME program. However, pre-registration is required as space is limited.

 

 

 

Advances in thrombolysis

Bill Likosky, MD, FAAN, FAHA, Director for Stroke and Telestroke, Swedish Neuroscience Institute

 

 

Washington State has one of the high­est stroke mortality rates in the nation. To improve this situation, acute intervention­al therapies for stroke are being employed to restore circulation to ischemic brain tissue that surrounds areas of completed infraction, while avoiding risk of hemor­rhage due to reperfusion of large areas of infracted brain tissue.

Urgent thrombolysis with intrave­nous alteplase is the only therapy known to improve clinical outcomes following acute stroke. Unfortunately, alteplase has had limited usage because many patients arrive in an emergency department after the three-hour treatment window. The FDA has also approved two clot removal devices based on the ability to restore circulation. These devices are used up to eight hours after symptom onset. Several approaches to improved acute stroke care are now under way, including extension of the thrombolysis window to 4.5 hours, identification of safer thrombolytic agents and research identifying brain at risk of in­farction following a stroke.

A recent European study demonstrat­ed the efficacy of alteplase up to 4.5 hours after ischemic stroke in patients younger than age 80 years who have neither dia­betes mellitus or prior stroke. The safety profile during this longer window for these patients appears similar to that at three hours.

Another promising advance employs a new thrombolytic agent called des­moteplase. Derived from the saliva of the vampire bat, this agent has a longer half life than alteplase and does not break down basement membranes, leading to a lower risk of hemorrhagic complica­tions. The Swedish Stroke Program is part of an international effort to test this drug in a nine-hour window.

Todd Czartoski, M.D., and Bart Keogh, M.D., Ph.D., are collaborat­ing with the stroke team at Stanford University to identify patients with vi­able ischemic tissue regardless of time from onset of symptoms. Perfusion MRI identifies impaired blood flow in brain (the “penumbra”) surrounding an infarct. In cases where there is a large area at risk, the use of alteplase or clot retrieval may prove beneficial long after the three-hour window has elapsed.

Telestroke is another important development in acute stroke care. This program enables the timely alteplase treatment of patients in emergency rooms around the Pacific Northwest that lack onsite neurological expertise.

For more information about the Swedish Stroke Program, contact Sherene Schlegel, R.N., FAHA, at 206-320-3484. For information about telestroke, contact Tammy Cress, R.N., MSN, at 206-320-3112.