This month, the ANA speaks to Muhammad Alvi, MD, Assistant Professor, Medical Director of Stroke at J.W. Ruby Memorial Hospital, Berkeley Medical Center, WVU Rockefeller Neuroscience Institute. Dr. Alvi speaks about “silent strokes,” the use of Tenecteplase, and more.
1. What does the public need to understand about strokes that it often doesn’t?
I think of stroke as a heterogeneous disease. There are many different scenarios where the end results in stroke. For example, patients with atrial fibrillation can have a stroke due to clots formed in the heart while patients with carotid stenosis can have a stroke to plaque disruption. Therefore, stroke management and prevention have to be individualized.
Additionally, we see a fair number of patients having what we call “silent strokes.” This is where we obtain an MRI of the brain for a different reason other than stroke — for example, balance problems — and we find a prior injury to the brain in the form of a silent stroke that did not cause any obvious stroke symptoms, but there is definite damage. There are multiple factors behind the development of these silent strokes, some of which are modifiable. This is also an area of my personal interest when it comes to understanding the mechanisms behind this injury.
2. How are treatment options for strokes different today from 10 years ago?
Treatment options for stroke have rapidly evolved over the last 10 years. In the acute management of stroke, mechanical thrombectomy has revolutionized the treatment of strokes. This is where the clot in the brain is removed via wires and catheters under image guidance. In rightly-selected patients, this can be a game changer.
Additionally, over the last couple of years tenecteplase has achieved fairly widespread implementation in acute thrombolysis in stroke. Previously our option was limited to alteplase, but with the addition of tenecteplase we have more options with some evidence that tenecteplase may be superior to alteplase in some sub-groups of stroke patients.
Lastly, when it comes to secondary prevention in stroke, more treatment options are available. Medications like ticagrelor or cilostazol are available in addition to aspirin or clopidogrel for secondary stroke prevention.
3. What promising research is poised to change the standard of treatment for strokes?
There are multiple areas of research that are being pursued to improve the recovery in patients with stroke. Despite our best efforts, there is a large subset of stroke patients that are left with residual deficits resulting in disability. Two promising avenues here are stem cell treatment in stroke recovery which has shown very promising results, but needs more work to become a standard of care.
In the recent past, blood substitution studies in mice with stroke have shown dramatic improvement in stroke deficits by robustly reducing the size of the infarct.
4. What work is your lab undertaking to move understanding or treatment for strokes forward?
I have been collaborating with some basic science researchers over the last five years. My main area of interest is to better understand the pathophysiology behind the development of cerebral small vessel disease. We have an animal model that results in small, subcortical strokes. Here, we are trying to understand the mechanisms of injury to the brain. Additionally, we are trying to study various medicines to see if we can prevent or minimize the damage to the brain in this model.
I am also collaborating with researchers who are studying blood substitution studies in mice with stroke. We are working on our next steps to see if we can take this idea from bench to bedside.
5. How has the ANA supported your career and/or work in this area?
I have attended several of the ANA Annual Meetings. The research presented is top notch. I have been honored to present my research at Annual Meetings several times. Additionally, I have been able to connect with other collaborators and researchers at the Annual Meeting.
Another useful ANA resource has been the ability to utilize the mentoring network, which was especially useful when I was starting out as junior faculty.
Want to learn about more of the groundbreaking research being conducted by ANA members? Read past editions of The ANA Q&A.