Neurosurgeon Tackles Stroke Complication

Marie_LPN, RN, LPN, RN · Jul 12, 2005

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By Sarah Barry / Daily Progress staff writer

July 2, 2005

For the last 50 years, neurologists have struggled to better understand what causes a cerebral vasospasm, a dangerous complication that can follow stroke treatment.

Dr. Neal Kassell, who has been studying strokes for more than 40 years, refers to vasospasms as his "bête noire," as the complication has remained untreatable for decades. Recently, though, promising results from preliminary studies at the University of Virginia Medical Center and from Germany have led Kassell to believe that a cure may be in sight.

Kassell, the co-chairman of the department of neurological surgery, says the new treatment is aimed at patients who have suffered a hemorrhagic stroke as a result of a burst aneurysm. When the aneurysm, or weak spot in the artery, bursts, blood leaks between the brain and its membrane.

The blood leak can then cause a reaction. "The reaction causes the arteries in the brain to narrow over a period of time, usually seven to nine days," Kassell said. If the arteries become too constricted, the patient can suffer a second stroke.

The new drug, which Kassell calls "the most promising thing I've seen in 40 years," works by blocking endothelin, the chemical that causes the arteries to constrict. Doctors have only recently been able to make significant strides in coming up with a treatment because, as Kassell points out, "we didn't even know about endothelin 10 years ago."

The studies ultimately will involve 400 patients at centers around the world, all of whom will have suffered a ruptured artery. The first patient in the United States to participate in the study was Norma Freday, a 67-year-old woman from Roanoke. She was treated at the UVa Medical Center by Kassell, and as he puts it, "She is normal now."

According to Britt Drewes, a spokeswoman for the American Stroke Association, stroke is the "No. 3 killer of Americans but the No. 1 disabler." While ischemic strokes mostly affect the elderly, "the average age for a ruptured aneurysm is 50 or 51," Kassell said. The ASA, which is a division of the American Heart Association, recently estimated that 700,000 Americans suffer a stroke each year, and 163,000 die.

Virginians particularly are part of the "stroke belt," along with other Southern and Mid-Atlantic states, Drewes said. "We are in the tobacco states where there is a higher rate of smoking."

Kassell first became interested in strokes in 1964. "I was working in a hospital and I saw a young woman who had a ruptured aneurysm," he said. The woman had survived surgery and seemed to be doing well. But a week later, her arteries constricted, and "her heart stopped working and she died," Kassell said.

Since then, Kassell has remained devoted to cerebrovascular neurosurgery, and particularly to treating vasospasms. While he is "very optimistic" that there will be a cure or prevention developed in the next five years, he is anxious to see vasospasms eliminated. "I highly suspect this treatment will be part of the armamentarium that is used against it," Kassell said. But, he adds, "It's a challenge to see who will last the longest, it or me."