SMART stroke study improves patient access to lifesaving therapies

California Pacific CURRENTS: The online journal of CPMC Research Institute

March 17, 2016

Time is of the essence for treating acute ischemic stroke (AIS) and preventing permanent damage to the brain. The only FDA-approved drug for acute ischemic stroke is recombinant tissue plasminogen activator (rt-PA/thrombolytic therapy), administered intravenously.

Pioneering research at CPMC determined that current criteria for thrombolytic therapy to treat AIS are unnecessarily complex. “The SMART (Simplified Management of Acute Stroke using Revised Treatment Criteria) approach is a new method enabling physicians to quickly and efficiently determine which patients will benefit from thrombolytic treatment,” says Nobl Barazangi, MD, PhD, a neurologist and Director of the CPMC Stroke and Neurocritical Care Research and Education Program at CPMC’s Comprehensive Stroke Care Center. “This approach significantly reduces the number of barriers by eliminating unnecessary exclusion criteria to administering thrombolytic therapy, while maintaining safety and efficacy of treatment.”

Nationally, fewer than five percent of patients with AIS receive lifesaving thrombolysis (using the clot-busting drug, rt-PA), one of the most effective and accessible treatments available for stroke. At CPMC—home to one of the best stroke care and research programs in the U.S.—that rate averages over 25%, one of the highest rates nationwide.

New research by CPMC’s stroke team was published last month in the Journal of Stroke and Cerebrovascular Diseases. Dr. Barazangi, David Tong, MD, Director of the CPMC Comprehensive Stroke Care Center, research fellow Sigrid B. Sørensen, MD, and colleagues showed that expanding the use of the SMART approach to outlying ‘spoke’ hospitals (including rural/ community hospitals) in addition to comprehensive stroke care centers such as CPMC results in good neurologic outcome at discharge and low complication rates.

The retrospective study of more than 500 AIS patients treated over four years produced results comparable to those reported in randomized controlled trials. Rates of intracranial hemorrhage—a complication of thrombolytic therapy—were low.

“We believe this study shows that the SMART criteria may be used broadly and not just at stroke centers, may help increase treatment for acute ischemic stroke nationally, and will hopefully encourage dialogue in the stroke community to revise the current rt-PA criteria,” says Dr. Barazangi.