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(Stroke. 2002;33:311.)
© 2002 American Heart Association, Inc.

Comments, Opinions, and Reviews

NINDS-Sponsored Clinical Trials in Stroke: Past, Present, and Future

John R. Marler, MD

From the National Institute of Neurological Disorders and Stroke, Rockville, Md.

Correspondence to John R. Marler, MD, Neuroscience Center, Room 2216, 6001 Executive Blvd, Rockville, MD 20892. E-mail marlerj@ninds.nih.gov

	Introduction

 
For the past 25 years, the National Institute of Neurological Disorders and Stroke (NINDS) has been encouraging and supporting major multicenter, randomized, controlled clinical trials evaluating medical and surgical interventions to prevent and to treat stroke. More than a score of trials involving more than 20 000 participants have assessed antiplatelet agents, anticoagulants, thrombolysis, carotid endarterectomy, hormone replacement, and psychosocial interventions (Figure). Since 1977, the NINDS has spent more than $200 million on clinical trials in stroke, the bulk during the past decade. This large investment of public research dollars is justified by the huge public health burden due to stroke, amounting to billions of dollars yearly in the United States, and the savings in health care dollars garnered to date by the results of NINDS-sponsored clinical trials, which have paid their way and more.

View larger version (61K): [in this window] [in a new window]   Major clinical trials funded by the National Institute of Neurological Disorders and Stroke. For trials not yet completed, number of patients is projected sample size. The total number of patients randomized in all of these trials will be 34056 when complete. For years after 2001, the number of funded trials may increase. The EXCITE Trial is funded largely by the National Institute of Child Health and Human Development.

NINDS-sponsored clinical trials are flagship studies in many areas of stroke, influencing treatment decisions daily in clinics throughout the world. When is carotid endarterectomy indicated for patients with cervical carotid stenosis? The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Atherosclerosis Study . . . [Full Text of this Article]