Dr. Justin Fraser discusses research and the Stroke Tissue Bank at UK HealthCare
UK HealthCare's Kentucky Neuroscience Institute is a Comprehensive Stroke Center and Dr. Justin Fraser is the Surgical Director of the center. He and researcher, Dr. Greg Bix are working on exciting breakthroughs in stroke treatment that may one day lead to reversing the damage caused from stroke. For more information visit
Transcript:
Here our research collaboration is kind of twofold. So you have the understanding of stroke pathology and really learning about stroke in humans in a way that we never knew before. And then you have the treatment. How do we improve treatment?
So to the first side of things or the first angle, we decided that we wanted to look at stroke in humans in a way we couldn't before. And thrombectomy as a procedure offers us that window, a window that we didn't have before. So when we go up through the blood vessel to reopen that blocked blood vessel, here is our clot sitting in the blood vessel. We have to go through it first in order to deploy our devices to get it out.
In the process of doing that procedure, blood is removed distal to the clot and in front of the clot and the clot itself. All of that is removed. And for years, we were throwing it in the garbage, because it was tissue that came out. It was, here's this clot. We never want to see that again. Get that out of the patient. And it would go to the garbage.
And I'd say, well, that's silly. We're in a position where this is something that is precious. It gives us a window into stroke. And so we designed a protocol so that we capture all of that, the blood in front of and behind the clot and the clot itself.
When we have a stroke patient come in, and I or one of my partners decides to perform the thrombectomy, we say, go. And when we say go, our pagers go off. And this is a pager that is carried by me as an interventionist. It's carried by our entire thrombectomy teams of the technicians, the nurses. We all swarm to the angio suite to do the procedure as quickly as possible.
But there's one more pager. That pager's carried by our researchers. And so they know to come. And we take the tissue, and we actually have a small lab set up adjacent to the angio suite where they can process the tissue and save it for things like gene expression analysis, look at the proteins that are in there, and understand the acid base balances.
So we're able to look at the tissue in many ways and preserve it, actually, in a tissue bank. And so if a year from now or two years from now, we say, hey, we want to go look back at this thing we didn't even think about before, we'll have the capability to do it.
The tissue bank is linked up to a patient-protected confidential database where we can maintain information about age, co-morbidities, where did the clot come from, how much time occurred or the time intervals. What was their imaging? How did they do after the stroke, in terms of how big their strokes were?
And so we're able to link the clinical back to these basic science questions. What I can tell you is we've enrolled, I believe, 26 patients at this point. And the information that we've gotten from them so far is stuff we never know about stroke before.
Dr. Justin Fraser discusses how research is changing stroke treatment
Nearly 2,000 people in Kentucky died of stroke in 2010*. It’s the fifth leading cause of death in the Commonwealth. And even those who survive often face a lifetime of disability.
At UK HealthCare, we’re on a mission to provide the highest level of stroke care possible. And to turn those statistics around.
Our Stroke Center has earned Comprehensive Stroke Center status – the highest rating a stroke center can achieve. We’re one of only four centers in Kentucky and only 100 nationwide to earn this designation.
Dr. Justin Fraser is the Director of UK HealthCare Cerebrovascular Surgery and the Surgical Director of the UK Comprehensive Stroke Center. He, along with researcher Dr. Greg Bix are changing the way stroke is studied and striving to find the treatment that will one day reverse the effects that a stroke can have on the brain.
More information about the leading edge stroke treatment happening at the Kentucky Neuroscience Institute at
Transcript:
When I say stroke, it's important for people to understand what that is. There's two categories of stroke. There's hemorrhagic stroke and ischemic stroke. Hemorrhagic stroke is essentially a sudden bleed in the brain that occurs without trauma. That can occur because of an aneurysm in the brain or from longstanding hypertension or from a host of other diseases. That's a small category stroke.
The much larger category is what we call ischemic stroke, and simply defined that is essentially an acute or immediate blockage in a blood vessel that provides blood supply to the brain. And when that happens that part of the brain is affected. It's not receiving the blood supply it needs it's not receiving oxygen and glucose.
And that part of the brain will start to undergo damage. And for years we had no treatments. Once the blood vessel got blocked, the stroke was going to occur and the emphasis was on getting that person through it safely, and rehabbing them. In 1995, and actually years leading up to that of course, but there was a large study looking at a drug called TPA, tissue plasminogen activator. And simply put, it's a clot buster. It's a drug that breaks apart blood clots in the blood vessel.
And so that was a major leap forward for us because we were able to take a clot that we couldn't previously dissolve and now dissolve it. The next leap forward was over the last decade and that's been the development of a procedure that allows us to physically remove that clot.
Think of it like, I like to say it's glorified plumbing so to speak, right? So just like you could snake the plumbing in your house when it gets clogged up, it's like a similar procedure in the brain. So the name for that procedure is thombectomy. And how it works is patients have an acute stroke and we know and we've discovered through very rapid scanning of the brain with CT scans that they have a blockage up here in the blood vessel.
We can whisk them up to our angio suite, it's kind of like an operating room with an x-ray machine inside. And we go up into that blood vessel that's blocked and we have a number of tools that we can use to remove that clot to take it out of the body and reestablish blood flow to that part of the brain.
Years ago that might take several hours to do. The technology has improved to a point where it can take 10, 12, 15, 17 minutes to do. And so our ability to do the procedure and to do it safely has greatly increased, allowing us to really treat patients in a way we could never before.
And so in 2015, multiple clinical trials published their results where they were essentially saying OK. If a person comes in with an acute blockage in a large blood vessel in the brain, large artery, and we either give them best medical therapy, plus TPA, or we do all of that plus this new thrombectomy procedure, which group does better?
And it's one of the only times in medicine I can think of where four clinical trials all reported extremely positive results all at the same time. So instantaneously, we went from a situation where this procedure, this thrombectomy procedure was being performed in academic centers like ours to it now becoming one of the most effective treatments in all of medicine.
And so, that combined with TPA have empowered us as physicians, as health care providers, to really change the outcome for stroke. And so our thought was, let's focus, at least initially, on a subset of patients and that subset are the ones we take to thrombectomy. Because they're, it's a group with potentially very large strokes, so the chance of seeing a treatment effect is much greater, right? Because if we don't treat them they're going to have a terribly large stroke.