Michael R. Frankel, MD, professor of neurology at Emory University School of Medicine, and chief of neurology for the Grady Health System, is principal investigator for a pioneering stroke study designed to reduce the risk of recurrent strokes and improve health outcomes for stroke patients.
The multi-center study, Secondary Prevention of Small Subcortical Strokes (SPS3), is a randomized, controlled trial aimed at defining effective therapies for prevention of stroke recurrence as well as thought and behavioral decline in patients with asymptomatic small subcortical stroke. This stroke causes a small, "pea-sized" spot of damage in deeper areas of the brain, which control, memory, movement, concentration, and balance. Small subcortical strokes comprise about 25 percent of brain infarcts, and are commonly seen in African Americans and Hispanic Americans. The major risk factors are advancing age, hypertension and diabetes.
"The primary aim of the study is to determine what the best treatment is for people who have had a small subcortical stroke," Dr. Frankel explains. "These strokes can lead to significant disability as well as memory loss and impaired thinking. The damage that it does to the arteries and brain is quite common. Unfortunately, it's too common."
Despite the frequency and importance of these strokes, little is known about secondary prevention. The study aims to determine whether a combination of aspirin and Clopidogrel, a blood thinner, is superior to aspirin alone for preventing cognitive decline. It will also look at whether aggressive, or intensive, blood pressure lowering is superior to standard hypertension management, according to current guidelines from the American Heart Association on managing blood pressure. Joyce Doyle, MD, associate professor of medicine at Emory, is working with Dr. Frankel as the hypertension expert in the project.
"We're very interested in enrolling patients at Grady because hypertension is extremely common and affects over 80 percent of the patients we see with stroke," Dr. Frankel says. "Small subcortical strokes are the most common type of stroke that we see. The question is, can we reduce the risk of a second stroke better than we're currently doing, especially since we know that once you've had a stroke you're at risk of having another one."
The five-year study is being funded by the National Institute of Neurological Disorders, and involves 35 clinical sites throughout the United States. The University of Texas at San Antonio is the coordinating center for the study.
The study also involves the Departments of Neurology and Internal Medicine at Emory, both of which are working closely to enroll, identify and manage patients over time. Ten to 20 patients each year will be recruited at Grady and Emory.