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Research

telestroke-lss-researchAt the heart of the Lone Star Stroke Consortium’s mission is research that will improve the lives of all Texans affected by stroke and cerebrovascular disease. LSS has established a state-wide network for patient-centered stroke research and therapeutic trials within Texas. The network links academic health institutions with proven expertise in stroke research to community stroke centers.

Projects Under Way

LESTER  is a database that captures preliminary, clinical, treatment, and long term outcomes data on all stroke patients treated via the telestroke network of the Lone Star Stroke Consortium. The goal of the database is to  understand the patterns, mechanisms, and impact of regional stroke care in the context of expanding the telestroke network in the state of Texas. We seek to understand how stroke care is delivered and how outcomes are achieved with the use of telemedicine.

NAS-Care uses telemedicine to improve the efficiency of the process for giving clot dissolving stroke medicines in emergency departments.

V-STOP II will help stroke patients self-manage their risk factors to prevent a second stroke.

V-STOP III will determine the effectiveness of providing Video-Teleconference (VT) delivery of patient self-management education and stroke secondary prevention services to Texas residents with a history of stroke who are at increased risk for second stroke and other vascular events due to poorly controlled vascular risk factors.

Can MRI Identify Cardioembolic Stroke? This project is the first in a planned series of studies to develop and validate a brain imaging biomarker of cardioembolic stroke toward the long term goal of identifying a high risk group that may preferentially benefit from long term cardiac monitoring or anticoagulation in the absence of proven cardioembolic source.

EnRICH (Efficient Resource Utilization for Patients with Intracerebral Hemorrhage)
Are 90-day outcomes for spontaneous ICH patients with same risk subset associated with level of care? What is the comparative effectiveness for management of spontaneous ICH patients at a higher level of care? The Lone Star Stroke Consortium, with its network of hub and spoke hospitals, provides a unique opportunity to answers these questions. The first logical step towards developing evidence based recommendations is to study the regional patterns of care for ICH patients. Regional data are imperative to obtain detailed and granular information on in-patient and long term outcomes like resource utilization and functional and quality of life for ICH patients treated both at CSCs and non-certified community hospitals. These data are also necessary to study various transfer related decision parameters.

IAT-TiMeS (Intra-arterial Transfer Time Metric Study) aims to describe the current landscape of IAT transfer times at Texas CSCs to identify barriers/delays in the transfer process (phase 1). We will determine which hospitals have the longest and shortest transfer times and share the data with each of the LSS hospitals. Our objective is for each hospital to learn from each other and evaluate best practices associated with shorter transfer times that could be implemented throughout the network.

WISHES (Women’s Imaging of Stroke Hemodynamics Study) will attempt to determine candidate sex differences in cerebrovascular and hemodynamic predictors of stroke outcome for hypothesis generation from a retrospective database and prospectively test the hypothesis that sex differences in cerebrovascular and hemodynamic factors predict sex differences in stroke outcome.

START Optimal Delay Time to Initiate Anticoagulation after Ischemic Stroke in Atrial Fibrillation (START): a pragmatic, adaptive randomized clinical trial. Long-term oral anticoagulation is standard for secondary stroke prevention in patients with atrial fibrillation (AFib). However, there is limited data and no consensus on the timing of when to initiate anticoagulation therapy and concern that starting too soon risks symptomatic hemorrhagic transformation. These data are derived almost exclusively from heparins and Vitamin K antagonists (e.g.,warfarin). As NOACs are becoming a mainstay of stroke prophylaxis in AFib and have more rapid and consistent anticoagulation and fewer strokes (hemorrhagic especially) , the question of optimal timing of NOAC initiation is of increasing importance. Our primary aim is to determine the time-to-treatment interval with the lowest associated risk for adverse events in the context of anticoagulation therapy with NOACs for acute stroke patients with non-valvular AFib.

 

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