American Heart Association

Monthly Archives: June 2018

Author Interview: Dr. Sean Savitz, MD, on “Intravenous Cellular Therapies for Acute Ischemic Stroke”

Dr. Sean Savitz

Dr. Sean Savitz

A conversation with Sean Savitz, MD, Frank M. Yatsu M.D. Chair in Neurology, Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, on stem cell therapies for acute ischemic stroke.

Interviewed by Mark R. Etherton, MD, PhD, Assistant in Neurology, Massachusetts General Hospital, Instructor, Harvard Medical School.

They will be discussing the paper “Intravenous Cellular Therapies for Acute Ischemic Stroke,” published in the May issue of Stroke. The article is part of a Focused Update in Cerebrovascular Disease centered on stem cells and cell-based therapies.

Dr. Etherton: The data from MASTERS-1, as well as the animal studies, suggests a promising, immunomodulatory role for MAPCs in ischemic stroke, as well as for cells derived from other tissue sources. Can you speak to the advantages/disadvantages of MAPCs over other cell types?

Dr. Savitz: There are several advantages that make MAPCs appealing. One is that they have been studied extensively in pre-clinical animal models and now quite a bit in clinical trials, which has resulted in a significant amount of safety data obtained from these rigorously designed trials. So, in designing a therapy for stroke, I am of the opinion that it is important to choose a therapy based around animal studies and solid testing in early stage trials. We are encouraged by the fact that the clinical studies suggest MAPCs are safe in humans, and we already see signals suggesting that, if given in the right time window, the cells are effective to improve outcomes. In this respect, there are few if any other cell types that have gone this far on the continuum from animal studies to an impending phase 3 trial.

Author Interview: Dr. Bruce Campbell, on the EXTEND-IA TNK trial

Dr. Bruce Campbell

Dr. Bruce Campbell

A conversation with Dr. Bruce Campbell, MBBS (Hons), BMedSc, PhD, FRACP, co-principal investigator of the EXTEND-IA TNK trial and Head of Stroke at Royal Melbourne Hospital, University of Melbourne, about EXTEND-IA TNK and its implications for stroke care.

Interviewed by Kaustubh Limaye, MD, an Assistant Professor in the Division of Cerebrovascular Diseases at the University of Iowa (@kaustubhslimaye).

They will be discussing the article “Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke,” published in The New England Journal of Medicine.

EXTEND-IA TNK randomized 202 ischemic patients with large vessel occlusion 1:1 between 0.25mg/kg tenecteplase and 0.9mg/kg alteplase prior to endovascular thrombectomy. The proportion of patients who had substantial (>50%) reperfusion or no retrievable thrombus on the initial angiographic assessment was approximately doubled in the tenecteplase group (22% vs. 10%), which met the non-inferiority threshold (p=0.002) and was indeed superior (p=0.03) to alteplase. Functional outcomes at day 90 were also significantly improved in the tenecteplase group in ordinal (shift) analysis of the modified Rankin Scale. Symptomatic intracerebral hemorrhage occurred in 1/101 patients in each group.

Dr. Limaye: First, accept my heartiest congratulations for the completion and success of the EXTEND-IA TNK trial. I think the results will benefit acute stroke patients with large vessel occlusion and open up more avenues in streamlining care of such patients. Would you like to share with our readers the timeline of this trial – from conceptualization to execution?