- The stroke is a very common disease,
the brain is not getting enough blood flow
because either a blood vessel becomes hardened and narrowed,
or it's blocked by a blood clot or it ruptures
or it ruptures because the blood vessel wall becomes weak leading
to bleeding within the brain or around the brain.
- Time is critical in these situations
because the longer a blood vessel stays blocked,
the more brain cells will die.
- There's few things more devastating
than a patient having a stroke.
It affects their identity, their ability to be productive.
Decades ago when you see somebody with a stroke
you would provide your empathy
and then you'd have to move on
because there wasn't much to offer.
Doing stroke research, investing in stroke treatments
was thought to be a graveyard that's changing.
This is reinvigorating stroke research
very broadly speaking.
- There's an urgency to diagnose
through clinical evaluations and neuroimaging
and then offer the best treatments
that we can for these patients.
- Getting those therapies earlier,
results in better outcomes.
Earlier is important, time matters.
When you think about stroke,
one of the fundamental things that you need to do
is figure out what kind of a stroke patients are having.
The only way you can figure that out,
is by taking a look with a brain image
and MRIs is incredibly safe technology.
It's very powerful
but because of high magnetic field and power requirements,
it's usually in a basement.
And as a result, even though it's very important,
very difficult for patients to access.
Here at Yale, for the first time in the world
both developed and deploy a portable MRI machine.
We've taken MRI from that secure bunker,
and we've brought it to the bedside
and this has been incredibly exciting as you can imagine.
The pictures are getting better and better,
and we're constantly coming up with new ideas
for what we can do with a very exciting technology.
- Under normal circumstances,
the brain has the unique ability to regulate
its own blood flow.
Brain tissue is very vulnerable during the first hours
after stroke.
How do we manage blood pressure in the very acute phase
after someone has had a stroke?
The ideal blood pressure after someone has had a stroke,
depends on many factors.
So using a one size fits all approach
for blood pressure management after stroke,
it's likely inadequate.
We're currently using neuromonitoring technology
that helps us identify the blood pressure that's ideal
for this individual person,
so that the brain has the best chances
to heal from the stroke.
- When there's injury anywhere in the body,
the body sets up an inflammatory reaction.
The same thing happens in the brain.
And so we're trying to understand
how can we harness the immune systems knowledge
about how to repair tissues after they've been injured.
Once you've dealt with the initial blood vessel problem
either stopped the bleeding,
or reopened the blocked blood vessel,
we now have a lot of injury that's still ongoing over days.
By understanding what the signals are
that tell the immune system
to stop making pro-inflammatory factors,
and start making growth factors,
and start healing the brain,
we can find new therapies, new treatments
for patients with stroke that minimize that early injury
and really enhance their ability to recover.
- Those patients that come back from a severe stroke,
to go on and live a normal, meaningful life,
that's really inspiring,
even though we're up against a terrible disease,
but we're making progress.
We're constantly getting better and improving the therapies,
and that's because of clinical research.
- What motivates me is that the interventions and treatments
that we were evaluating and studying 10 years ago,
are now part of a standard of care, a clinical practice
which is enabling us to reduce death
and disability to our patients.
- What motivates me in the research realm
is thinking that at some point,
maybe one of the discoveries that we make in lab,
can actually translate into a new therapy
that would allow a patient to walk again
or speak again, or return to their normal lives.
- There's always something nice about trying
to attack something that people say can't be done.
We're gonna spread towards those areas
because they're important,
and because we like to do the unique thing.
- We want to be able to lead research efforts
that change the lives of patients around the world.