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    This Nasal Spray May Clear Your Brain, Not Your Sinuses


    And, if you think that nose drops to treat stroke sound like something Dr. McCoy would use on Captain Kirk, what about a laser that takes aim at blood clots deep inside the brain and pulverizes them? That's exactly what a new device called an Endovascular Photo Acoustic Recanalization laser, or EPAR for short, is supposed to do.

    Helmi Lutsep, MD, of the Oregon Stroke Center at Oregon Health Sciences University in Portland, is one of several researchers who tested the new laser in a safety trial. Based on that trial, the FDA has given the go-ahead for larger studies.

    Lutsep says the new laser, which was tested in 26 stroke patients, is small enough to be used in most blood vessels in the brain. Earlier lasers were too large or inflexible to be used in small vessels, she says.

    Goldstein says the EPAR laser is one of several lasers now being tested for what is called "mechanical clot disruption." While the devices are intriguing, he says there is a concern "that mechanical devices may accidentally dislodge other clots," thus causing additional damage while attempting to treat the original stroke.

    Another worry is that the devices, which have to be threaded through very tiny vessels using guide wires, may actually tear the delicate walls of blood vessels in the brain. Goldstein says, for example, that Lutsep's group reported three such tears in the 26 patients treated in their safety study. Lutsep says those three patients had no ill effects from the tears, but according to Goldstein, "they were lucky."

    Lutsep, however, shrugs off criticism because she says that laser technology is likely to triumph in the end for a very simple reason: time. Once inside the brain, the EPAR laser "can dissolve a clot in 36 seconds," she says, while it takes clot-busting drugs almost an hour," even if you deliver the drug directly to the site of the clot."

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