With a high prevalence of risk factors including age, diabetes, high blood pressure and high cholesterol, Avera’s Brain & Spine specialists see a high volume of strokes among patients who come from a wide catchment area.
Because Avera clinicians want to provide patients with the best possible care protocols for optimal outcomes, Avera has launched into stroke clinical trials as a member of StrokeNet, a National Institutes of Health (NIH)-funded clinical trial network consisting of nearly 500 U.S. sites.
Gaining Momentum in Stroke Research
Avera Research Institute, a division of Avera McKennan Hospital & University Health Center, joined StrokeNet in 2022, and began participating in clinical trials in 2023 – the same year Avera McKennan also received its first certification as a Comprehensive Stroke Center by DNV.
This effort was spearheaded by Rwoof Reshi, MD, Avera neurocritical care physician who currently serves as the site director for StrokeNet at Avera.
“Dr. Reshi’s work and leadership in getting Avera Research Institute established as a StrokeNet site served as a spark for an entire stroke research program at Avera,” said Tony Larson, Research Associate at the Avera Research Institute.
During these past few years, several Avera stroke clinicians have launched their own investigator-initiated research studies focused on improving stroke outcomes closer to home. “These studies involve combining the passion and clinical excellence of our stroke clinicians with the research infrastructure and expertise we have at the Avera Research Institute,” Larson said.
“Our investigator-initiated studies aim to better understand the stroke population that Avera serves, population disparities within the Avera footprint, and how novel treatment and system-based paradigms can improve patient outcomes,” said Randy Bell, MD, Avera neurosurgeon and Medical Director of Avera’s Comprehensive Stroke Program.
Clinicians’ interest continues to grow as Avera deepens its involvement with stroke research, Larson added.
Stroke-Related Clinical Studies
The first two StrokeNet clinical trials involved therapies that could prevent future strokes in patients. Avera researchers and providers screened new stroke patients to see if they met criteria and had willingness to participate.
Anticoagulation in Intracranial Hemorrhage Survivors for Stroke Prevention and Recovery, known as the ASPIRE study, tests the efficacy and safety of the anticoagulation drug apixaban, compared with aspirin, in patients with both a recent intracranial hemorrhage (brain bleed) and atrial fibrillation. Which therapy is safer and more effective in preventing additional strokes or brain bleeds in such patients is not currently known. The study, which seeks to enroll a very specific group of participants, can be difficult to enroll patients into.
“Despite strict inclusion and exclusion criteria, we consented two patients for this study—this number is on par with many larger, urban-based academic medical centers,” Larson said.
The SleepSMART study aims to determine whether treatment of obstructive sleep apnea with a CPAP after an ischemic stroke or high-risk transient ischemic attack reduces the risk of another stroke and improves outcomes. “This study has recently met its enrollment goal, and we were able to contribute a total of four patients to the overall study population—a significant accomplishment and testament to the hard work of our stroke clinical trials team,” Larson said.
The stroke clinical trials team at Avera has recently been selected to participate in another clinical trial through StrokeNet. This trial, MINUTE, will assess the safety and efficacy of a novel, minimally invasive surgical technique for removing brain hematomas from patients who have suffered an intracranial hemorrhage (brain bleed). Avera neurosurgeons will be traveling to New York to be specially trained to perform this new technique.
This new surgical procedure would be in addition to interventional neuroendovascular procedures to remove a clot that is causing a stroke or repair a damaged blood vessel via a micro-catheter; these procedures are already standard of care at Avera.
A System-Wide Approach for Stroke
For consistency across the Avera system, stroke care is a “hub and spoke” model, with Avera McKennan as a certified Comprehensive Stroke Center as the hub, and community and critical access hospitals as the spokes.
“Regardless of their location, whenever someone experiences possible stroke symptoms, we want them to get to the nearest emergency room as quickly as possible,” Larson said. There, they receive diagnostic imaging plus any initial medications for fast intervention.
Confirmed stroke patients may be transported by ground ambulance or Careflight to Avera McKennan, for additional treatment, whether that’s clot-busting medications or interventional neuroendovascular procedures, as well as ICU care and rehab.
“We’re working at the state level and also the system level to improve stroke care and research plays a big role in that,” Larson said. “A lot of the research work we’re doing is very clinically focused, using our data to improve care for the patients we see on a daily basis.”
Learn more about stroke and aneurysm care at Avera.
