Approximately 150,000 people in the UK suffer a stroke every year, due either to a blocked blood vessel (causing ischaemic stroke), or a burst blood vessel (which causes haemorrhagic stroke). Whilst there are effective treatments for stroke (stroke unit care, thrombolysis, thrombectomy) unfortunately many patients still die or are left disabled and dependent on others.
Our clinical research covers the whole stroke pathway from the management of acute stroke (blood pressure lowering, remote ischemic conditioning, tranexamic acid for intracerebral haemorrhage), acute prevention of recurrence (antiplatelets), ISMN (Isosorbide Mononitrate commonly used to treat angina), Cilostazol (used to prevent more strokes from happening), enhancing recovery (stem cell mobilisation), and prevention of cognitive decline (intensive blood pressure and/or lipid lowering).
Our laboratory studies investigate the blood brain barrier and how its integrity may be maintained after a stroke.
What we are doing in...
1. Clinical studies
The Nottingham Stroke Trials Unit runs a number of large multi-centre phase 3 clinical trials, both in the UK and Internationally. In addition, we also run a number of smaller phase II clinical trials, as well as performing systematic reviews and meta-analysis. (List of clinical stroke trials.)
- Phase I trials in volunteers
- Phase II and phase III trials in acute stroke, stroke recovery and stroke prevention
- Meta-analysis using both summary and individual patient data
- Data (safety) monitoring committees
- Remote Ischemic Conditioning After Stroke Trial (RECAST-3)
- Desmopressin for reversal of Antiplatelet drugs in Stroke due to Haemorrhage (DASH)
- LACunar Intervention-2 Trial (LACI-2)
- Rate risks and Routes to Reduction of Vacular Dementia (R4VaD)
2. Systematic reviews
- Acute interventions
- Secondary prevention
- Recovery and rehabilitation
3. Translational studies
Our translational studies focus on the elucidation of the mechanisms that may account for the breakdown and recovery of the blood-brain barrier (BBB) with an aim to discover novel therapeutic mediators that can effectively prevent or reverse the formation of brain oedema, the main cause of death within the first week after an ischaemic stroke.
Translational stroke studies
- Role of stem cells in post-stroke neurovascular regeneration.
- Protein Kinase C signalling pathways in hyperglycaemia - and ischaemia-induced cerebral and vascular damage.
- NADPH oxidase system and ischaemic cerebral vascular damage.
- Endothelial senescence and dysfunction - chronological ageing.
- Endothelial Progenitor Cells - inflammation, angiongenesis and neurovascular recover.
- Therapeutic hypothermia - neurovascular unit recovery.
- Diagnostic and Prognostic clinical biomarkers for stroke subtypes.
Our research impact is reflected in the following:
Publications in leading journals e.g. Stroke, Lancet, New Eng Journal
- Sprigg N, Selim, M., Hanley, DF., Steiner, T., Christensen, HK., Lafuente, J., Rodriguez, D., Keep, RF., Anderson, C., Parry-Jones, AR., Nilsson, M., Stibrant Sunnerhagen, K., Novick, E., Aronowski, J., Lawson, B., Chaudhary, N., Zhou-Ping, T., Zuccarello, M., Wood, D., Shoamanesh, A., Qureshi, A., Cordonnier, C., Klijn, CJM., Al-Shahi Salman, R., Gregson, B., Mendelow, AD., Gaudin, C., Pandey, AS., Ziai, W., Alcazar-Romero, PP., Montaner, J., Marti-Fabregas, J., Nilsson, S., Schenk, B., Riess, H., You, C., Gaist, D., Broderick, J., Recommendations for Clinical Trials in ICH. The Second Hemorrhagic Stroke Academia Industry Roundtable. Stroke, 2020
- Sprigg N, Law, ZK., Ali, A., Krishnan, K., Bischoff, A., Appleton, JP., Scutt, P., Woodhouse, L., Pszczolkowski, S., Cala, LA., Dineen, RA., England, TJ., Ozturk, S., Roffe, C., Bereczki, D., Ciccone, A., Christensen, H., Ovesen, C., Bath, PM. Noncontrast Computed Tomography Signs as Predictors of Hematoma Expansion, Clinical Outcome, and Response to Tranexamic Acid in Acute Intracerebral Hemorrhage. Stroke 2020
- Bath PM, Anderson, CS., Huang, Y., Lindley, R., Chen, X., Arima, H., Chen, G., Mbiostat, QL., Billot, L., Delcourt, C., Broderick, JP., Demchuk, AM., Donnan, GA., Durham, AC., Lavados, PM., Lee, TH., Levi, C., Martins, SO., Olavarria, VV., Pandian, JD., Parsons, MW., Pontes-Neto, OM., Ricci, S., Sato, S., Sharma, VK., Silva, F., Song, L., Thang, NH., Wardlaw, JM., Wang, JG., Wang, X., Woodward, M., Chalmers, J., Robinson, TG., Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial. The Lancet, 2019.
Bath PM, Woodhouse LJ, Krishnan K, Appleton JP, Anderson CS, Berge E, Cala L, Dixon M, England TJ, Godolphin PJ, Hepburn T, Mair G, Montgomery AA, Philips SJ, Potter J, Price CI, Randall M, Robinson TG, Roffe C, Rothwell PM, Sandset EC, Sanossian N, Saver JL, Siriwardena AN, Venebles G, Wardlaw JM, Sprigg N. Prehospital Transdermal Glyceryl Trinitrate for Ultra-Acute Intracerebral Hemorrhage: Data from the (RIGHT-2) Trial. Stroke, 2019
- Bath PM, Appleton, JP., Woodhouse, LJ., Bereczki, D., Berge, E., Christensen, HK., Collins, R., Gommans, J., Ntaios, G., Ozturk, S., Szatmari, S., Wardlaw, JM., Sprigg, N., Rothwell, PM. Effect of Glyceryl Trinitrate on Heodynamics in Acute Stroke. Stroke 2019
See details of more publications under individual researchers' profiles.
Safety and Efficacy of Triple Antiplatelets for reducing dependency after Ischaemic Stroke; The TARDIS randomised controlled trial.
Tranexamic acid for hyperacute primary Intracerebral Haemorrhage (TICH-2).
Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2): Assessment of safety and efficacy of transdermal glyceryl trinitrate, a nitric oxide donor, and of the feasibility of a multicentre ambulance-based stroke trial.
DMT-EPC Endothelial progenitor cells: potential biomarkers for diagnosis and prognosis of ischaemic stroke.
See our other major awards from funders including the NIHR HTA and the Stroke Association.
NIHR Senior Investigator award
Professor Philip Bath, head of the Stroke Research group, has been named an Emeritus Senior Investigator after the closure in March 2020 of his previous award of NIHR Senior Investigator. Senior Investigators are the NIHR’s pre-eminent researchers and include some of the nation’s most outstanding leaders of clinical and applied health and social care research.
We maintain strong collaborative links with key groups both within the University of Nottingham and outside with colleagues in the UK, Europe and worldwide.
Projects recently collaborated include:
UK: Edinburgh (LACI-2, R4VAD, RESTART); UCL (CROMIS-2), LSTHTI (TICH-2)