Vascular Neurology Research
Clinicians in the Division of Vascular Neurology are dedicated to advancing stroke research at NYU Langone’s Comprehensive Stroke Center and Center for Stroke and Neurovascular Diseases. NYU Langone is one of the regional coordinating centers for the National Institutes of Health’s StrokeNet research collaboration, a network of more than 200 hospitals across the United States that serves as the infrastructure and pipeline for potential new treatments for people with stroke and those at risk for stroke. Our team participates in various stroke-related clinical trials and basic science research in the area of vascular neurology.
One of our goals is to place our division at the forefront of basic science innovation in new therapies in acute stroke treatment. This led us to the investigation of the use of intravenous dextran as an adjunct to tissue plasminogen activator (tPA) therapy in acute stroke. Dextran has antithrombotic properties and changes the zeta potential of platelets and erythrocytes, causing electrostatic repulsion and inhibiting the formation of a new thrombus after tPA use.
Dextran also precipitates the cross-bridging of monomers by fibrin in a clot, which increases the surface area of the clot that is open to attack by the tPA molecule. This would enhance use of tPA in the tPA time window and may also be of use in the area of intra-arterial or endovascular interventions, where a thrombus may be in distal areas not amenable to endovascular intervention.
Use of High-Molecular-Weight Dextran to Enhance Effective Thrombolysis in Ischemic Stroke Patients Treated with tPA
Albert S. Favate, MD, and Raymond V. Mirasol, MD, are studying whether systemic administration of dextran, given as a bolus concomitantly with tPA, may be of benefit in the treatment of acute ischemic stroke. They hypothesize that this will lead to improved thrombolysis as a result of increased plasmin activity, decrease the likelihood of further thrombosis caused by antiplatelet activity, and make any subsequently formed thrombus more susceptible to plasmin.
Smaller volumes of dextran may be administered locally during endovascular intervention. Our researchers postulate that the concentrations achieved locally will enhance local plasmin activity, decrease platelet and erythrocyte participation in subsequent thrombus formation, and lower the risk of systemic complications, such as congestive heart failure, renal failure, and thrombocytopenia.
Use of N-Acetylcysteine and Dextran in Acute Stroke Patients Outside of the Conventional Intravenous tPA Window
This trial, led by Dr. Favate and Dr. Mirasol, is based on the use of N-acetylcysteine and dextran for thrombus dissolution in stroke. This regimen may be an option for patients who are not eligible for tPA or do not receive treatment within the tPA time window and who are not candidates for intra-arterial intervention.
Restoring Motor Function After Stroke by Augmenting Neuroplasticity
Heidi Schambra, MD, and colleagues in her laboratory are advancing the treatment of motor impairment and disability after stroke. Dr. Schambra’s lab uses a range of methodologies, such as motion capture, machine learning, targeted training paradigms, and noninvasive brain stimulation, to augment motor skill learning and recovery in the upper limbs and to probe brain circuitry and motor control.
Dr. Schambra’s lab recently received a 5-year, $936,000 K02 Independent Scientist Award from the National Institute of Neurological Disorders and Stroke to further the lab’s quantitative rehabilitation research. The aim of the project is to develop a pair of measurement tools to be used in neurorehabilitation, enabling the precise measurement of feasible rehabilitation dose and motor recovery after stroke.