Top

Published in:

Open Access 01-01-2010

The Evolution of Transcranial Laser Therapy for Acute Ischemic Stroke, Including a Pooled Analysis of NEST-1 and NEST-2

Authors: Andrew B. Stemer, Branko N. Huisa, Justin A. Zivin

Published in: Current Cardiology Reports | Issue 1/2010

Abstract

Intravenous tissue plasminogen activator is the only proven therapy for acute ischemic stroke. Not enough patients are eligible for treatment and additional new therapies are needed. Recently, laser technology has been applied to acute ischemic stroke. This noninvasive technique uses near-infrared wavelengths applied to the scalp within 24 h of symptom onset. The mechanism is incompletely understood but may involve increased mitochondrial adenosine triphosphate production. Animal models demonstrated safety and efficacy warranting randomized controlled trials in humans. NEST-1 (phase 2) and NEST-2 (phase 3) confirmed the safety of transcranial laser therapy, although efficacy was not found in NEST-2. Pooled analysis of NEST-1 and NEST-2 revealed a significantly improved success rate in patients treated with laser therapy. Further phase 3 testing is planned and may create a new paradigm for the treatment of acute ischemic stroke.

Lloyd-Jones D, Adams R, Carnethon M, et al.: Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009, 119:480–486.CrossRefPubMed

Thom T, Haase N, Rosamond W, et al.: Heart disease and stroke statistics—2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2006, 113:e85–e151.CrossRefPubMed

Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group [no authors listed]. N Engl J Med 1995, 333:1581–1587.CrossRef

Kidwell CS, Shephard T, Tonn S, et al.: Establishment of primary stroke centers: a survey of physician attitudes and hospital resources. Neurology 2003, 60:1452–1456.PubMed

Kleindorfer D, Lindsell CJ, Brass L, et al.: National US estimates of recombinant tissue plasminogen activator use: ICD-9 codes substantially underestimate. Stroke 2008, 39:924–928.CrossRefPubMed

Saver JL: Hemorrhage after thrombolytic therapy for stroke: the clinically relevant number needed to harm. Stroke 2007, 38:2279–2283.CrossRefPubMed

Hoffman JR, Schriger DL: A graphic reanalysis of the NINDS trial. Ann Emerg Med 2009, 54:329–336, 336.e1–336.e35.

Alberts MJ: tPA in acute ischemic stroke: United States experience and issues for the future. Neurology 1998, 51:S53–S55.PubMed

Hacke W, Kaste M, Bluhmki E, et al.: Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 200, 359:1317–1329.

10.

Hacke W, Donnan G, Fieschi C, et al.: Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004, 363:768–774.CrossRefPubMed

11.

Priestley J: Experiments and Observations on Different Kinds of Air. Edited by Bowyer W, Nichols J. London: Oxford University; 1774.

12.

Einstein A: Zur quantentheorie der strahlung [on the quantum theory of radiation]. Phys 1917, 18:121–128.

13.

Maiman T: Simulated optical radiation in ruby. Nature 1960:493.

14.

Solomon KD, Fernandez de Castro LE, Sandoval HP, et al.: Lasik world literature review: quality of life and patient satisfaction. Ophthalmology 2009, 116:691–701.CrossRefPubMed

15.

Spencer JM, Hadi SM: The excimer lasers. J Drugs Dermatol 2004, 3:522–525.PubMed

16.

Mavrogiannis M, Thomason JM, Seymour RA: Lasers in periodontology. Dent Update 2004, 31:535–538, 541–542, 545–547.

17.

• Zivin JA, Albers GW, Bornstein N, et al.: Effectiveness and safety of transcranial laser therapy for acute ischemic stroke. Stroke 2009, 40:1359–1364. This is the first phase 3 study of TLT; safety was demonstrated but efficacy did not meet formal statistical significance.CrossRefPubMed

18.

Hacke W, Kaste M, Fieschi C, et al.: Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Stroke Study (ECASS). JAMA 1995, 274:1017–1025.CrossRefPubMed

19.

Hacke W, Kaste M, Fieschi C, et al.: Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 1998, 352:1245–1251.

20.

Clark WM, Albers GW: The ATLANTIS rt-PA (Alteplase) Acute Stroke Trial: final results. Stroke 1999, 30:234.

21.

Oron A, Oron U, Chen J, et al.: Low-level laser therapy applied transcranially to rats after induction of stroke significantly reduces long-term neurological deficits. Stroke 2006, 37:2620–2624.CrossRefPubMed

22.

Streeter J, De Taboada L, Oron U: Mechanisms of action of light therapy for stroke and acute myocardial infarction. Mitochondrion 2004, 4:569–576.CrossRefPubMed

23.

Lapchak PA, De Taboada L: Transcranial near infrared laser treatment (NILT) increases cortical adenosine-5'-triphosphate (ATP) content following embolic strokes in rabbits. Brain Res 2009 Oct 23 (Epub ahead of print).

24.

Shen J, Xie L, Mao X, et al.: Neurogenesis after primary intracerebral hemorrhage in adult human brain. J Cereb Blood Flow Metab 2008, 28:1460–1468.CrossRefPubMed

25.

Detaboada L, Ilic S, Leichliter-Martha S, et al.: Transcranial application of low-energy laser irradiation improves neurological deficits in rats following acute stroke. Lasers Surg Med 2006, 38:70–73.CrossRefPubMed

26.

Carnevalli CM, Soares CP, Zangaro RA, et al.: Laser light prevents apoptosis in Cho K-1 cell line. J Clin Laser Med Surg 2003, 21:193–196.CrossRefPubMed

27.

Oron A, Oron U, Streeter J, et al.: Low-level laser therapy applied transcranially to mice following traumatic brain injury significantly reduces long-term neurological deficits. J Neurotrauma 2007, 24:651–656.CrossRefPubMed

28.

Lapchak PA, Wei J, Zivin JA: Transcranial infrared laser therapy improves clinical rating scores after embolic strokes in rabbits. Stroke 2004, 35:1985–1988.CrossRefPubMed

29.

Lapchak PA, Salgado KF, Chao CH, Zivin JA: Transcranial near-infrared light therapy improves motor function following embolic strokes in rabbits: an extended therapeutic window study using continuous and pulse frequency delivery modes. Neuroscience 2007, 148:907–914.CrossRefPubMed

30.

• Lampl Y, Zivin JA, Fisher M, et al.: Infrared laser therapy for ischemic stroke: a new treatment strategy: results of the NeuroThera Effectiveness and Safety Trial-1 (NEST-1). Stroke 2007, 38:1843–1849. This is the first phase 2 study with TLT that demonstrated safety and effectiveness.CrossRefPubMed

31.

Clark WM, Wissman S, Albers GW, et al.: Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA 1999, 282:2019–2026.

32.

• Lapchak PA, Han MK, Salgado KF, et al.: Safety profile of transcranial near-infrared laser therapy administered in combination with thrombolytic therapy to embolized rabbits. Stroke 2008, 39:3073–3078. This is the first study to demonstrate that TLT could be administered safely with tPA in rabbits.CrossRefPubMed

Title: The Evolution of Transcranial Laser Therapy for Acute Ischemic Stroke, Including a Pooled Analysis of NEST-1 and NEST-2
Authors: Andrew B. Stemer
Branko N. Huisa
Justin A. Zivin
Publication date: 01-01-2010
Publisher: Current Science Inc.
Published in: Current Cardiology Reports / Issue 1/2010
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-009-0071-3

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The Evolution of Transcranial Laser Therapy for Acute Ischemic Stroke, Including a Pooled Analysis of NEST-1 and NEST-2

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2010

Indications and Applications of Arterial Stents for Stroke Prevention in Atherosclerotic Intracranial Stenosis

Radiation Dose Reduction in CT Coronary Angiography

Stroke in Women: Disparities and Outcomes

Detecting Unrecognized Myocardial Infarction: The Importance of Imaging

In Vivo Imaging and Monitoring of Transplanted Stem Cells: Clinical Applications

Cardiovascular Magnetic Resonance of Myocarditis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page