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Brainstorm

The chaotic effects of a stroke and the brillant idea to prevent them

April 2003

An estimated 700,000 Americans will suffer a stroke this year. Many will become paralyzed. Many others may lose the ability to speak properly or think clearly. But many others will get a second chance thanks to Oscar Benavente, M.D., associate professor of neurology, and Robert Hart, M.D., professor of neurology.

Drs. Benavente and Hart are directing the world’s first preventive study of small subcortical strokes. Their work could diminish the most frequently occurring type of stroke in South Texas.

"Small subcortical strokes account for 27 percent to 30 percent of all ischemic strokes (strokes caused by inadequate blood supply to the brain) and occur most frequently in African and Mexican Americans," Dr. Benavente said. "Roughly half the strokes in Mexican Americans in San Antonio are small subcortical strokes."

A small subcortical stroke is the result of the obstruction or blockage of the small arteries in the brain. While it’s not usually fatal, it often strikes again, predisposing patients to dementia. "We know that blood pressure control reduces stroke recurrence," Dr. Benavente said. "But we don’t know how low blood pressure should be adjusted in patients who suffered a stroke."

The National Institutes of Health (NIH) awarded Drs. Benavente and Hart a $37 million grant to determine the most effective way of preventing small subcortical strokes.

The team will direct a nationwide study involving 35 clinical sites and more than 2,500 patients. "This study will involve patients who have already had at least one small subcortical stroke," Dr. Hart said. "We will determine the best way to prevent recurrent strokes and cognitive decline by controlling blood pressure and using anti-clotting agents."

Researchers will monitor the effects of aspirin alone and aspirin taken in combination with the anti-clotting agent clopidogrel. In addition, hypertensive patients will be assigned to two targets of blood pressure control - below 130 mmHg of systolic and between 130 and 149 mmHg. "The hypothesis is that the two anti-platelet agents combined and the more intensive blood pressure control will be more effective at preventing further strokes and dementia," Dr. Benavente said.

The research began in 1999 with a pilot study, also funded by the NIH. This is Phase III of the study and will last five years.





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