Ep 119 -- Stem Cells and Thrombectomy with Dr. Dileep Yavagal


Click here for a machine generated transcript.

Mission Thrombectomy 2020+ is an initiative to double the number of mechanical thrombectomies around the world. This initiative, driven by Dr. Dileep Yavagal, aims to help more stroke survivors, communities, and economies in the developed and developing world by reduces the level of disability cause by stroke.

We talk about that initiative this week, but first we get an update on Stem Cells.

Dr. Yavagal was a guest on Strokecast back in episode 42. We talked his work in stem cell research to treat acute stroke patients. The work was promising but still experimental.

It still is.

Dileep gives us an update on the progress and research protocols involving the treatment. The bottom line is there is NO approved stem cell therapy in the US today. Research has not sufficiently demonstrated safety and effectiveness. But they're working on it.

The only stem cell therapy available for stroke is experimental in research studies. If you choose to participate in those studies, great! Research studies provide the treatment for free.

If someone tries to charge you or collect a fee for stem cell therapy, run, hobble, or wheel away as fast as you can. It is not a legitimate therapy at this time.


Dr. Yavagal headshot

Dr. Dileep R. Yavagal, MD, FAHA, FAAN, FSVIN is the Director of Interventional Neurology and Co-Director of Neuroendovascular Surgery at the University of Miami & Jackson Memorial Hospitals and Clinical Professor of Neurology and Neurosurgery at the University of Miami School of Medicine. He has recently been appointed to lead the Neurological Cell Therapy Platform at the Interdisciplinary Stem Cell Institute at the University.

Dr. Yavagal is an international thought leader in endovascular therapy for ischemic and hemorrhagic stroke as well as a pioneer in the translation of intra-arterial delivery of cell therapy for stroke. He was the national Co-PI of the first US multicenter clinical trial of Intra-arterial delivery of autologous bone marrow stem cells for ischemic stroke: RECOVER Stroke. He was on the on the steering committee of the SWIFT-Prime and MR RESCUE, both landmark randomized clinical trials of endovascular stroke therapy. He co-authored the landmark 2015 AHA Endovascular Stroke Therapy Guidelines as well as the recent groundbreaking DAWN stroke trial in the New England Journal of Medicine. He is the founder and Past-President of the Society for Vascular and Interventional Neurology (SVIN). He has also co-authored the AHA Policy statement on Stroke Systems of Care.

Dr. Yavagal has received several state and federal research grants to study endovascular stem cell therapies for ischemic stroke using small and large animal models of stroke in his research laboratory. He is considered a pioneering researcher the field of intra-arterial delivery of stem cells in stroke therapy.

Dr. Yavagal is Chair of the Society of Vascular and Interventional Neurology’s (SVIN) global campaign called Mission Thrombectomy 2020+ (MT2020+) and is leading a no-holds-barred charge to accelerate access and remove geographic disparities to mechanical thrombectomy (MT), an interventional treatment for a common type of disabling stroke.

MT2020+ is calling on public health policymakers to increase physical, financial and diagnostic access to MT for patients with disabling strokes.

Stem Cell Updates

Dr. Yavagal's research is about the use of stem cell therapy to treat stroke patients in the first few days of their stroke -- the acute phase. The process his team is exploring involves placing the donor stem cell at the point of injury by using a catheter through the groin or wrist. This method is similar to his other key projects around mechanical thrombectomy. Both involving similar equipment -- a catheter the surgeon navigates through the patient's arteries to remove or deliver a payload. And it takes place in an angio suite, which is an operating room with special imaging equipment.

In a study with the patients' own cells, his team has demonstrated safety, and they have seen results indicating effectiveness, too, even though the study wasn't designed for it.

Recent large animal studies have demonstrated that the process is safe. The next step is to do studies to demonstrate the safety of donor stem cells with humans. Then they can explore effectiveness.

At this point (January 2021) there are no FDA approved stem cell therapies for stroke patients. But we're getting there.

Mission Thrombectomy 2020+

Mechanical Thrombectomy is the gold standard for the treatment of large vessel ischemic stroke, especially when combined with tPA.

In mechanical thrombectomy, a surgeon runs a catheter from the femoral artery in the groin or radial artery in the wrist. They navigate to a clot in the brain and drag it out to restore blood flow.

tPA is a clot busting medicine that works to break up clots in the body to restore blood flow.

When both treatments are used, patients experience much better outcomes.

The challenge is they have to be used quickly. Patients have only 90-minutes to 24 hours to get treatment. The actual window varies widely based on the details of the patient's stroke, MRI, general health, and the specifics f the hospital they get to.

Most of the time, the window is 3 hours That window has been growing though.

When I had my stroke in June of 2017, the window was much smaller. I woke up with symptoms so I had my stroke sometime between 1:00 AM and 7:00 AM. That put me outside the window for the interventions at the time. Six months later the window expanded, and it continues to get better.

Would my right MCA at the basal ganglia thrombus been eligible for removal a few months or a year later if my stroke had just held off a little longer? I'm not sure I want to know.

Mission Thrombectomy 2020+ is an initiative led by Dr. Yavagal to double the number of thrombectomies performed around the world in both developed and developing countries.

A large part of the work involves creating national and regional committees to work with local health ministries. The committees educate politicians, government officials, administrators, and health care influencers on the benefits of mechanical thrombectomy for patients and society.

Disability and shortened life is expensive for a community. It's expensive from the loss of the inherent value of human life and quality of life for many survivors. But it's also expensive in sheer economic impact.

Long term treatment costs money. Loss of worker productivity costs money. Loss of productivity from caregivers costs money. The opportunity cost from untreated stroke is enormous.

In many cases. Prompt mechanical thrombectomy can save lives, reverse some stroke damage, and dramatically reduce the number and severity of disabilities a survivor will live with.

When you can make a case for reducing both human and economic costs, you've got a pretty compelling case.

That's the case Mission Thrombectomy 2020+ makes around the world.

The Jet Plane Comparison

Thrombectomy isn't cheap to start up. You need Angio Suites -- specialized emergency room with specialized imaging equipment. It requires super tiny catheters to go through the blood vessels to retrieve the clots. And it requires expert training for neurosurgeons, nurses, and all the other folks who make hospitals work.

How can developing nations or less prosperous communities in developed nations afford all that?

If they see the value, they'll find a way.

Dr. Yavagal compares it to jet travel. Smaller communities or developing nations still often have air service. That's expensive, too. Airport runways aren't just blacktop highways. Airport infrastructure is much more complex and expensive than it looks. Airplanes are expensive. Maintenance on aircraft is expensive. Staff to fly and repair planes require specialized skill.

How can so many places afford it?

Because the see the value air travel brings. It's critical infrastructure to develop and prosper. And it brings tremendous benefits in both human and economic capital.

They find the money because they see the value.

And that's the goal of Mission Thrombectomy 2020+.

Mission Thrombectomy 2020+ has produced a whitepaper talking about the importance of Thrombectomy and why a community needs to make the treatment available. You can read it here: Mechanical Thrombectomy for Acute Stroke-Building Stroke Thrombectomy Systems of Care in Your Region: Why & How?

Hack of the week

Find your ducks.

We talked with Sarah Parsloe in Episode 111 and Bill Torres in Episode 110.

Sarah tells the story of how Bill feeds the ducks every day. Many stroke survivors struggle with being the recipient of care. This is especially true for those of us who were always trying to take care of others before our strokes. When we're not able to do that anymore, it can be tough.

Bill found the ducks that needed help after his stroke. Even as he worked to recover, each day he fed the ducks at a local pond. He still does. Taking care of the ducks is a great way to help out after stroke -- it's a way to feel needed and to put value back into the world. Being able to contribute -- to make a difference -- is something we all need.

So find your metaphorical or literal ducks and go feed them.


Where do we go from here?

Here is the latest episode of The Strokecast

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