Physicians in the Stroke Center participate in the Department of Neurology’s activities in patient care, teaching, and research. The current faculty members are Patricia Davis, MD, Harold Adams, MD, and Enrique Leira, M.D. Heena Olalde, RN, Jeri Sieren, RN, and Erin Rindels, RN, are the nurse coordinators in the Division. In addition, the Division has had physician fellows who are graduates of neurology residencies and who are seeking additional training in vascular neurology.

The Stroke Center, in the Division of Cerebrovascular Diseases, has had a number of accomplishments related to clinical research in prevention or treatment of persons with vascular diseases of the nervous system. Besides testing the utility of promising medical or surgical therapies to prevent or treat stroke, physicians in the Division of Cerebrovascular Diseases have helped develop important clinical instruments that are used around the world. The two most prominent are:

1. The National Institutes of Health Stroke Scale— this clinical rating instrument that can be used by physicians or other medical personnel to document the severity of stroke was developed at the University of Cincinnati and The University of Iowa. This scale now is used around the world because of its ease in use and strong predictive power.
2. The Trial of Org 10172 in Acute Stroke Treatment Classification— this system was developed by physicians at the University of Iowa to help categorize the causes of brain infarction. This classification system now is used around the world in clinical research on stroke.

The Division of Cerebrovascular Diseases has several ongoing clinical trials which they are participating in and recruiting subjects for:

AiRDOC— Antacids in-flight Reduce Disability Overcoming Complications: A randomized study of IV Ranitidine vs. placebo in ischemic/hemorrhagic stroke patients transported by helicopter to UI Hospitals and Clinics.

CLOSURE I Study— A Randomized Trial Comparing Transcatheter Patent Foramen Ovale Closure With the STARFLEX® Septal Occluder to Best Medical Therapy in Selected Stroke & TIA Patients.

COSS— Carotid Occlusion Surgery Study

IRIS Study— Insulin Resistance Intervention after Stroke Trial: A secondary prevention trial for stroke patients that are found to be insulin resistant.

SWISS Study— Siblings with Ischemic Stroke Study

The Division of Cerebrovascular Diseases has recruited patients in several studies that have been funded by the National Institutes of Health or private (usually pharmaceutical company) sources. The studies performed in the past include:

• Abciximab (ReoPro®) in Acute Ischemic Stroke: A Phase III, Multinational, Multicenter, Randomized, Double-blind, Placebo-Controlled Trial (AbESTT-II)
• Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA)
• Management of Atherothrombosis with Clopidogrel in High-Risk Patients with Recent Transient Ischemic Attack or Ischemic Stroke: A Randomized, Double-Blind Study, with 18 months of Follow-up (MATCH)
• Trial of Org 10172 in Acute Stroke Treatment (TOAST) looked at the usefulness of a blood-thinning agent (anticoagulant) in improving outcomes after stroke when the medication was started within 24 hours of the stroke
• North American Symptomatic Carotid Endarterectomy Trial (NASCET)— determined the usefulness of an operation (carotid endarterectomy) to prevent stroke among persons with warning symptoms of stroke and severe narrowing of the carotid artery
• Asymptomatic Carotid Atherosclerosis Study (ACAS)— determined the usefulness of carotid endarterectomy to prevent stroke among persons with severe narrowing of the carotid artery and no warning symptoms of stroke
• Warfarin-Aspirin Recurrent Stroke Study (WARSS)— compared the usefulness of aspirin or warfarin (Coumadin®) in preventing a second stroke among persons who do not have stroke secondary to heart disease. As part of this study, two additional projects looked at the usefulness of warfarin or aspirin in preventing recurrent stroke among persons with a hole in the heart (patent foramen ovale) or abnormal antibodies (antiphospholipid antibodies).
• Asymptomatic Carotid Artery Plaque Study (ACAPS) evaluated the usefulness of cholesterol lowering medications to slow the progression of narrowing of the carotid artery in persons with elevated cholesterol levels
• Ticlopidine-Aspirin Stroke Study (TASS)— compared the usefulness of ticlopidine (Ticlid®) or aspirin in preventing stroke among persons who have had warning symptoms
• Canadian-American Ticlopidine Study (CATS)— tested the usefulness of ticlopidine in preventing recurrent (second) stroke
• Stroke Prevention Atrial Fibrillation Study-I (SPAF)— compared the usefulness of aspirin or warfarin (Coumadin®) in preventing stroke among persons who had irregular heart beat (atrial fibrillation)
• Cooperative Aneurysm Study— examined the ideal time for surgery to treat patients with ruptured aneurysms and bleeding
• International Study on Unruptured Aneurysms— looked at the risk of bleeding among persons who have aneurysms and to look at the usefulness of surgery in preventing bleeding among this group of persons
• International Study on Extracranial-to-Intracranial Artery Anastomosis (EC/IC Bypass Study)— tested an innovative operation to prevent stroke

The University of Iowa also has held a Cerebrovascular Clinical Research Center contract with the National Institutes of Health. As part of this contract, the University of Iowa has done preliminary work on the usefulness of MRI to evaluate patients with stroke, the potential usefulness of naloxone to treat stroke, of nicardipine to prevent complications of hemorrhage, and of the blood thinner, Org 10172 to treat stroke.