Leading the way for improved stroke care

April 02, 2025

Mayo Clinic is committed to studying potential new treatments for neurovascular care. As a major center, Mayo Clinic in Jacksonville, Florida, participates in multiple national studies of cutting-edge approaches.

"We run a number of trials that demonstrate we're thought leaders in neurovascular care," says William D. Freeman, M.D., a vascular neurologist at Mayo Clinic's campus in Florida. "Our three shields of patient care, research and education flow around the needs of the patient. We work to offer patients hope."

Recent investigations have focused on improved treatment for hemorrhagic stroke and better poststroke recovery. Specific studies include:

FASTEST, which assesses the benefits of early administration of rFVIIa after acute spontaneous intracerebral hemorrhage.
BLOCK-SAH, which assesses opioid-sparing treatment for acute headache after subarachnoid hemorrhage (SAH).
STRIVE-ON, which assesses the safety of an injectable form of nimodipine for individuals after aneurysmal SAH.
C3FIT, which assesses a model of coordinated stroke care involving caregivers and families as well as patients.

"Our participation in these studies reflects our expertise and the quality of care we can provide for patients," says Lauren K. Ng, M.D., a neurocritical care specialist at Mayo Clinic's campus in Florida.

Focus on hemorrhagic stroke

In the past, clinical trials generally targeted ischemic stroke. More recently, attention shifted to hemorrhagic stroke. "We need to help these patients achieve better outcomes," Dr. Ng says. "There is very limited treatment right now for spontaneous intracerebral hemorrhage. Mortality and morbidity rates are extremely high."

The FASTEST study evaluates whether administering rFVIIa within two hours of hemorrhagic stroke onset might improve outcomes and decrease ongoing bleeding. "The focus is on patients whose CT scans indicate active bleeding," Dr. Freeman says.

BLOCK-SAH aims to improve outcomes for survivors of SAH, who often experience severe and refractory headaches. "Those headaches can be really disabling. Patients sometimes spend a month in the hospital just dealing with that pain," Dr. Freeman says. The study investigates whether a nerve block can ease those poststroke headaches.

STRIVE-ON seeks to determine whether intravenous (IV) nimodipine is a safe treatment for vasospasms, a common complication after aneurysmal SAH. Currently, oral nimodipine is the only approved form of treatment.

"The problem is that more than half of patients can't tolerate oral nimodipine," Dr. Freeman says. "The IV formulation, which is allowed in Europe, is better tolerated at a lower dose. Preliminary results from this latest IV study look positive."

Enhancing stroke recovery

Mayo Clinic is committed to improving not only acute stroke treatment but also poststroke recovery. C3FIT stands for "Coordinated, Collaborative, Comprehensive, Family-based, Integrated, Technology-enabled Stroke Care." It's a patient-centric model that seeks to enhance input from families and caregivers.

"We looked at diet, nutrition and other very practical factors to keep patients' blood pressure under control," Dr. Freedman says. "We followed patients via telemedicine and also surveyed and screened caregivers for burnout."

He notes that current standard of care relies on patients to arrange follow-up care after they leave the hospital. "A lot is put on their plates," Dr. Freeman says. "Our preliminary results indicate that patients in our C3FIT group do better on intermediate outcome measures than patients discharged with standard of care."

Mayo Clinic also is helping to investigate susceptibility to poststroke cognitive impairment, through the multicenter Determinants of Incident Stroke Cognitive Outcomes and Vascular Effects on RecoverY (DISCOVERY) clinical trial.

Participation in cutting-edge trials requires an experienced, multispecialty team. "We draw on expertise not only from our neurological intensive care clinicians but also our neurovascular surgeons and neurologists," Dr. Ng says. "There's a lot of mutual respect. Because of that, we can provide quality care for our patients."

Clinician-researchers are the core of Mayo Clinic's model of care. "The patient is at the center of everything we do," Dr. Freeman says. "We perform these studies in an effort to bring something back to the bedside."