NINDS conducts stroke research at its laboratories and clinics at the National Institutes of Health (NIH) and through grants to major medical institutions across the country.
NIH stroke research
A better understanding of the causes of stroke has helped people make lifestyle changes that cut the stroke death rate nearly in half in the last two decades. NINDS supports a wide range of basic and clinical research aimed at finding better ways to prevent, diagnose, and treat stroke, and restore functions lost due to stroke. And the NINDS Division of Intramural Research is home to hundreds of scientists who conduct leading-edge basic, translational, and clinical research in neuroscience, neurology, and neurosurgery research at NINDS laboratories in Bethesda, Maryland.
The overall goal of stroke research is to translate basic research findings into useful therapies and effective interventions for people with stroke. Basic research helps scientists gain new knowledge and increase their understanding of stroke. This research creates the foundation for diagnosing and treating stroke. Clinical research, which makes up for a large portion of stroke research, gives scientists a way to test new treatments for people—including surgical devices, procedures, medications, and rehabilitation therapies.
NINDS-supported scientists are working to develop new and more effective treatments for stroke, discover ways to restore blood flow to the brain after stroke, and protect brain cells from dying during and after stroke. Scientists are also looking at ways to improve rehabilitation and post-stroke recovery and learn more about the risk factors for stroke to discover new methods of stroke prevention. And researchers are using imaging techniques to learn more about how stroke affects the brain and which stroke treatments might be most effective.
NIH StrokeNet
NINDS created a stroke clinical trials network that serves as the infrastructure and pipeline for exploring new potential treatments for people with stroke and those at risk for stroke. The NIH StrokeNet, a centralized coordinating and data management center with 27 regional coordinating centers that are linked to more than 650 stroke hospitals across the U.S., conducts small and large clinical trials and research studies to advance acute stroke treatment, prevention, and recovery and rehabilitation following a stroke. Since its inception in 2013, StrokeNet has completed ten stroke studies and is currently conducting 16more.
The NINDS-funded DEFUSE 3 trial, which was conducted through StrokeNet, used advanced techniques in brain imaging to identify individuals who still might benefit from having blood clots physically removed outside of the traditional six-hour window of use from stroke onset. This trial demonstrated that thrombectomy, conducted up to 16 hours after the stroke began, led to improved outcomes compared to standard medical therapy in selected individuals. Advanced brain imaging helped identify which patients could benefit from restoring blood flow beyond standard treatment timelines.
The recently completed ARCADIA trial, a stroke prevention study conducted in StrokeNet, sought to determine whether apixiban, an anticoagulant medication used to prevent a stroke in people with atrial fibrillation could help people who had a stroke with an undiagnosed source of the blood clot and signs of atrial cardiopathy. Atrial cardiopathy refers to problems in the left atrium that increase the risk of having a stroke). The study, which was ended early, found that while the medication was safe to give in this population of patients, it was not effective in preventing a second stroke. A separate sub-study in ARCADIA, called ARARDIA-CSI, looked at whether apixiban helped prevent cognitive decline. While they observed a trend that indicated a slowing in cognitive decline, they were unable to definitively prove whether the medication offered any further protection. Further research is needed to address this question.
Learn more about NIH StrokeNet.
Research into more effective treatments for stroke
NINDS-funded research has been at the forefront of groundbreaking medical treatments for stroke, including the first approved drug to treat ischemic stroke—t-PA, or tissue plasminogen activator—and the finding that aspirin is just as effective as warfarin for preventing additional strokes. Researchers now hope to discover more effective medications and continue building on the success of t-PA.
Current NINDS-funded stroke treatment research includes:
Thrombolytic interventions
These inventions are designed to prevent further brain injury caused by the stroke by dissolving blood clots that block blood flow to the brain. Several projects are testing techniques such as combining thrombolytic drugs with other drugs and delivering clot-dissolving medications directly into the clot. Researchers also hope to find out if perfusion imaging can identify patients who can be effectively treated with t-PA when the timing of stroke onset is not known. The SISTER trial is a Phase II study testing a new monoclonal antibody medication as strategy for treating patients with an acute ischemic stroke who cannot receive the FDA-approved medications tPA or TNK within 4 and a half hours of the start of stroke symptoms.
Antithrombotic interventions
Antithrombotic medications are drugs that reduce the formation of blood clots. Through StrokeNet, the CAPTIVA trial is comparing whether the newer medications rivaroxaban and ticagrelor which can prevent blood clots that can cause a stroke are more effective than the older blood thinner clopidogrel in lowering the risk of stroke in patients with narrowing of intracranial arteries in the brain who have a high risk of having a major stroke. In another StrokeNet study called ASPIRE, investigators are comparing whether apixiban or aspirin are better for preventing a stroke in people who have atrial fibrillation have had a recent hemorrhagic stroke.
Restoring blood flow
Continuous blood flow to the brain is essential to brain cell health and function. Researchers are using neuroimaging techniques to gain a better understanding of how blood flows to the brain—when the brain is healthy and when it is not—to improve diagnosis, guide treatment, monitor response to therapy, identify new targets for therapy, and develop new treatments. In StrokeNet, the Stroke Thrombectomy Platform (STEP) uses an FDA-approved clinical trial protocol and novel statistical design to enable platform trials that will further determine which patient groups benefit from mechanical thrombectomy. STEP also makes it easier for stroke researchers to test new devices, supplemental medications and neuroprotectant strategies in an efficient, timely, and cost-effective manner.
Genetics
NINDS supports research to identify the role genetics play in stroke. Several rare inherited disorders cause an increased risk of stroke. Researchers hope to identify the genes responsible for other genetic disorders, with the goal of discovering treatments and learning more about stroke.
Recovery
NINDS-funded scientists are studying how the brain responds to experiences and adapts to injury to one section of the brain by having another part or parts take over and reorganize their functions. Noninvasive imaging technologies can map patterns of activity inside the brain to help understand this brain adaption. Other scientists are working to develop new and better ways to help the brain rewire and repair itself to restore basic functions following a stroke.
Rehabilitation
Despite recent advances in stroke treatment, more than half of people who have a stroke have lasting impairments. NINDS-funded scientists are looking at whether specific rehabilitative techniques, such as constraint-induced movement therapy (which involves restraining the unaffected hand and arm so that the person is forced to use the affected hand and arm for daily activities), direct current stimulation, or transcranial magnetic stimulation can kickstart brain plasticity and lead to improved motor function and decreased disability. In StrokeNet, NINDS-funded scientists are testing a treatment approach using home-based motor telerehabilitation compared to the usual care to determine if intensive rehabilitation therapy provided remotely using a telehealth approach will help patients better recover from stoke. This is particularly important because not everyone can access local stroke rehab centers.
Cerebroprotection
Recent advances in clot removal offer new opportunities to extend the time window to restore blood flow to the brain, protect surrounding tissue, and improve long-term functional outcomes using cerebroprotective agents (drugs or interventions to protect the brain and vascular cells). The NIH Stroke Preclinical Assessment Network (SPAN) aims to determine if an add-on intervention can improve outcomes compared to simply restoring blood flow alone. Using a multi-arm multi-stage design and under the direction of a Coordinating Center, six independent academic laboratories rigorously test candidates using a standard focal cerebral ischemic insult in multiple animal models that include both sexes and comorbidities.
Outreach programs
NINDS outreach programs also play an important role in linking research with people's everyday lives by educating individuals, their families and friends, and healthcare providers about the latest advances in treatment and prevention. The Know Stroke campaign encourages the public to learn the signs of stroke and to seek immediate medical help. Mind Your Risks® is a public health campaign that educates Black men with, or at risk of, high blood pressure about the importance of taking charge of their health. Controlling high blood pressure between the ages 28 and 45 can help reduce the risk of having stroke and developing dementia later in life.
Resources and Tools
NIH RePORTER
Use this searchable database to find current and past research projects supported by NIH and other federal agencies, including links to publications and resources from these projects.
NINDS Common Data Elements (CDE): Stroke
Common Data Elements (CDE) are standards that enable clinical investigators to systematically collect, analyze, and share harmonized data across the research community. NINDS strongly encourages researchers who receive funding from the Institute to ensure their data collection is compatible with these CDEs.
Learn More About NINDS CDEs: Stroke
NINDS funding opportunities
Learn about opportunities, how to prepare and submit applications, and more—including how to manage your award.
PubMed
A comprehensive biomedical search engine for articles from MEDLINE, life science journals, and online books.
NINDS clinical trials
For information about NINDS-funded trials for people who have had a stroke, see www.clinicaltrials.gov and search for “post-stroke and NINDS” and “stroke and NINDS.”