Agent of change

The stroke treatments pioneered by Professor Chris Levi and his team have transformed lives and medical practice.

As a clinician, Conjoint Professor Chris Levi sees evidence of the benefits of his research every time he sends a healthy patient home.

The internationally recognised stroke neurologist and researcher and the stroke research team at John Hunter Hospital, have driven breakthroughs in treatments and developed protocols that have vastly improved the outcomes for hundreds of stroke sufferers in the Hunter region. These approaches are now being adopted across Australia.

"For the right candidate, our treatment is dramatic – it is a cure for stroke," Levi says. "Twenty years ago, I would have said that was impossible."

Levi is the director of Acute Stroke Services at John Hunter Hospital.

The groundbreaking model of care developed by his team of medical researchers and clinicians combines the use of thrombolytic therapy, or 'clot-busting' drugs, with CT imaging of the brain. In suitable patients the clot-busting drug tPA can dissolve the blockage in their brain that has caused the stroke and prevent further damage. CT imaging is undertaken first to identify the areas of the brain that are salvageable.

Another integral part of the care model is a triage protocol that arms frontline health workers with the skills to identify stroke sufferers eligible for the treatment and fast track their passage to the acute stroke unit at the John Hunter Hospital. There is narrow four-and-a-half-hour window of opportunity for effective clot-busting therapy.

"By combining the treatments with our triage protocol we have improved our implementation of clot-busting therapy at John Hunter Hospital from 4 per cent of patients to over 20 per cent, which means more than 100 patients a year are receiving this therapy,'' Levi says.

"When successful, the treatment has great benefits for the patient – it can mean the difference between living dependently or independently.

"From a community perspective, it is also highly beneficial. With an estimated cost of up to $500,000 for a stroke patient with high care needs, the effective use of tPA is significantly reducing pressure on the health care budget."

Levi's stroke research group has attracted National Health and Medical Research Council grants to implement in hospitals across three states the combination of thrombolytic therapy and brain imaging. Hospitals across Sydney are also implementing the Hunter New England Health stroke treatment protocol.

Only about one third of stroke sufferers are suitable for tPA, and to receive it they must arrive at a hospital equipped to deliver the treatment within four and a half hours. The other two thirds of patients may be ineligible for a variety of reasons, including risk of excessive bleeding, past illnesses or contradictory drug treatments.

Because of this, Levi and his team are also leading research into treatments for those not eligible for thrombolytic therapy. One project is a joint study with Harbin Medical University in China, into methods of cooling the brain after a stroke.

The brain is put into hibernation, which 'buys' time for the clot to break up by itself. Researchers at Harbin are developing a helmet that works locally to cool the brain, while members of the team in Newcastle are experimenting with whole body cooling.

Newcastle researchers are also leading an international multi-centre trial of a new-generation clot-busting drug called tenecteplase or TNK, which they have shown in early trials to be more effective than alteplase or tPA.

Another exciting project is the Australian Stroke Genetics Initiative, led by Newcastle stroke researchers in collaboration with the University's Centre for Bioinformatics, Biomarker Discovery and Information-Based Medicine. Its first study, published this year in Nature Genetics, established a previously undiscovered genetic signal associated with a particular type of stroke.

"The wide range of research and the significant improvements to patient outcomes across all facets of stroke treatment verifies Newcastle's leadership role in this area," Levi says.

"Working at the nexus of stroke research and treatment, working with patients every day, spurs us on to keep moving developments from the lab and into clinical practice."

Professor Levi researches in collaboration with the Hunter Medical Research Institute's (HMRI) Brain and Mental Health Program. HMRI is a partnership between the University, the Hunter New England Local Health District and the community.

Visit the HMRI website