The outlook for Victorian stroke patients has improved dramatically in the past decade, thanks largely to our groundbreaking research that has been directly translated to patient care.
Stroke is a complex disease process, and its evaluation and management needs expert input from many fields. By working together, our researchers and clinical teams are treating patients more efficiently and with better outcomes.
Our stroke researchers are passionate about their work and their patients, and are involved in multiple studies and trials. A key 2021 study led by the Director of Neurology and Stroke, Professor Henry Ma, looked at the effect of COVID-19 on the management pathway of transient ischemic attack – TIA or mini-strokes.
“Before COVID-19, if a patient was deemed suitable for TIA pathway management, they would usually get a carotid ultrasound done within 24 hours, as an outpatient. This would identify any significant carotid artery stenosis, which is a narrowing in the large arteries on each side of the neck,” Professor Ma said.
“However, during COVID-19, to avoid asking the patient to return the next day, we performed the CT scan during the initial emergency presentation. This provided an immediate assessment of the carotid artery, which could then guide treatment.”
A Monash-led global review of COVID-19’s impact on acute stroke care found that our adaptive practices were delivering TIA rapid access pathways at a pace that matched other world-leading hospitals and universities. Monash Medical Centre emergency physician Dr Andy Lim said this research is pushing the frontiers of medicine.
“We are at a crossroads in stroke medicine, working closely with emergency stroke and neurology teams to work on large, minor and mini-stroke outcomes.” Until only a few years ago, 4.5 hours was the maximum time frame for thrombolysis (clot-busting) to be effective. However, our researchers are involved in trials that show this window could be extended to nine hours, and possibly much longer, by using computer imaging that identifies areas of dead tissue, potentially salvageable tissue, and undamaged tissue.”
Professor Ma is excited by the rapid improvements in treatment, from clot-busting to clot retrieval and removal, and extending the treatment time window.
“We now see patients coming into hospital with very disabling strokes able to leave hospital within a few days, nearly completely recovered – all thanks to research,” he said. “We support a research culture. We encourage all our junior medical staff, registrars and residents to conduct research to make an impact on the outcome of patients.”
For Dr Lim, the role of a clinical researcher is unique. “When you are in front of the patient giving them advice or explaining benefits and risks of a treatment or prescribing or administering a drug, it reflects the work of multiple teams … it is like standing on the shoulders of giants. And as a clinical researcher you can also bring insights, interpretations, and guidelines back to the laboratory and bridge the gap. It is a very special role that should be fostered to progress research.”
Spotting early stroke symptoms puts Bernie on a trial to recovery
Sharyn Burke’s quick thinking probably saved her husband’s life. “I noticed Bernie was very confused,” said Sharyn. “He wasn’t showing the typical signs of stroke, like facial drooping or slurred speech, but I knew something was wrong. When he started trying to put batteries into a computer mouse, I called Triple 0.”
Bernie decided to humour the paramedics when they arrived at his home. “I really had no idea why an ambulance was there, and why the paramedic was talking to me,” Bernie recalled. “My impression was that there was nothing much wrong with me, but I thought I’d humour them and go along to hospital.”
On arrival at the Emergency Department at Monash Medical Centre, Bernie displayed acute onset of speech problems, facial droop and visual field defect associated with stroke. “A stroke code was called, and he was assessed by the stroke team immediately,” explained Professor Henry Ma, Director of Neurology and Stroke at Monash Health and Professor of Medicine at Monash University.
When imaging showed a clot in Bernie’s brain, Sharyn gave permission for him to participate in the randomised TASTE trial. TASTE is an Australian trial comparing the standard clot-busting agent with a new medication that promises fewer side effects. It’s open to patients who have presented within 4.5 hours of stroke onset with demonstrable salvageable tissue. The TASTE trial received $3.9 million in funding through a National Health and Medical Research Council (NHMRC) grant. Bernie is one of 543 patients already recruited for the trial, which has a target of 832. “The patient has made a remarkable recovery with resolution of the symptoms,” Professor Ma said.
Bernie, a retired grandfather of five, says he now realises luck was on his side. “My wife is very clever – she knew the signs and picked it up right away,” he said. “I’m lucky that I got off so lightly. And my advice to anybody would definitely be to call an ambulance for any early symptoms of stroke.”
The full Monash Health 2021-22 Annual Report can be found here monashhealth.org.
Watch our Research and Academic Excellence video series featuring Professor Henry Ma here.
