Podcasts about comprehensive stroke center

Dr. Jahan will educate listeners about ischemic strokes, including their signs and symptoms, and the critical importance of calling 911 as soon as signs of stroke occur. Dr. Jahan will also highlight the expertise of The Division of Interventional Neuroradiology (DINR) team at Long Beach Medical Center, showcasing the latest minimally invasive treatment options available at Long Beach Medical Center's Comprehensive Stroke Center and how the care team provides exceptional care to their patients.

Chime In, Send Us a Text Message!Episode 74 Guest Lester Leung,MD- Founder Headway Neurology,LLCIn Season 2 Episode 7  we first interviewed Lester Y. Leung, MD, MSc of  Tufts MC.Dr Leung is a Board Certified Vascular & Neneral Neurologist, Assistant Professor of Neurology, Director, Comprehensive Stroke Center at Tufts Medical Center and Director and Founder, Stroke and Young Adults (SAYA) Program. In this episode we caught up with Dr. Leung again to learn about the launch of his new Advancing Stroke Recovery Program (ASR) at Headway Neurology,LLCHeadway Neurology LLC is a neurology micropractice based in Newton, MA. Dr. Leung has been serving Eastern Massachusetts and surrounding states since 2015. Headway Neurology operates as a direct care (self pay) practice in order to improve access and scheduling flexibility and minimize overhead (providing a more personal experience, unfettered by corporate healthcare). Learn more: https://www.headwayneurology.com/Instagram: https://www.instagram.com/lester.y.leung/Support Our Show! Thank you for helping us to continue to make great content. We appreciate your generosity! Support the Show.Show credits:Music intro credit to Jake Dansereau. Our intro welcome is the voice of Caroline Goggin, a stroke survivor and our first podcast guest! Please listen to her inspiring story on Episode 2 of the podcast.Connect with Us and Share our Show on Social:Website | Linkedin | Twitter | YouTube | FacebookKnow Stroke Podcast Disclaimer: Our podcast and media advertising services are for informational purposes only and do not constitute the practice of medical advice, diagnosis or treatment.

Meet Dr. Christopher M. Putman, a board-certified interventional neuroradiologist with over 20 years of experience. He treats a variety of complex intracranial, head and neck, and spine vascular conditions including acute stroke, cervical and intracranial stenosis, vascular malformations, cerebral aneurysm, and venous occlusive diseases. https://www.pacificneuroscienceinstitute.org/stroke-neurovascular/our-center/

Fiona Smith, a PhD student at the Cizik School of Nursing at UTHealth Houston and Stroke Coordinator at Houston Methodist Sugar Land Hospital, recently joined the Institute for Stroke and Cerebrovascular Diseases Stroke Busters podcast to discuss her research on stroke awareness within the Spanish-speaking community. Smith's passion for improving stroke care and reducing disparities in healthcare access has driven her to focus on the cultural factors that influence care-seeking behavior among Spanish speakers. Smith highlighted the importance of the RAPIDO acronym, a Spanish-language tool designed to help individuals recognize the signs of stroke and take action. RAPIDO, which translates to "fast" in English, stands for: R: Rostro caído (fallen face) A: Afectación de equilibrio (balance impairment) P: Pérdida de fuerza en los brazos (weakness in the arms) I: Impedimento visual (visual impairment) D: Dificultad para hablar (difficulty speaking) O: Obtener ayuda (obtain help) Smith emphasized that while the RAPIDO acronym is an essential tool for stroke recognition, it is equally important to understand the cultural factors that may influence an individual's decision to seek care. Her current research focuses on identifying these variables and developing strategies to ensure that everyone seeks care as quickly as possible when experiencing stroke symptoms. Smith also stressed the importance of collaboration among healthcare professionals, including nurses, doctors, therapists, and technologists, in making significant changes to improve stroke care in the community. She encourages healthcare professionals and researchers passionate about addressing cultural barriers to find mentors and advisors who can provide guidance and support in pursuing their research goals. Fiona Smith's dedication to improving stroke awareness and care within the Spanish-speaking community serves as an inspiration to healthcare professionals and researchers alike. Her work highlights the importance of understanding and addressing cultural factors in healthcare delivery and the power of community engagement in promoting better health outcomes for all. Stroke Busters, a Podcast Presented by: The Institute for Stroke and Cerebrovascular Disease at the University of Texas Health Science Center at Houston (UTHealth) or “Stroke Institute Genre: Medicine About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news in stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many who are experts in their field, to discuss their practice, cutting-edge research and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

One minute, you and a friend are talking about your weekend plans. And the next thing you know, you feel confused, have trouble speaking and start slurring words. That's what having a stroke feels like. If treated “fast” – and we'll get to what the acronym F.A.S.T. means - a stroke can be reversed and permanent disability prevented or minimized.  The longer the stroke lasts, the more brain damage occurs. The faster you treat it, the more brain you protect. F.A.S.T. represents the top signs of a stroke: F – Face Drooping; A – Arm Weakness; S – Speech Difficulty; and T – Time to call 9-1-1.  Host: David Jeannot Guests: Guilherme Dabus, M.D., Co-Director of Interventional Neuroradiology at Baptist Health Miami Neuroscience Institute Meisha McIntosh, Stroke Survivor

Young Stroke Survivor's Inspiring Journey Highlights the Power of Resilience, Support, and Research Katie was a healthy, active 27-year-old professional from Seattle starting her career, living life, and never expected it to be upended by a stroke. She woke up one morning and began her day like any other when suddenly her life changed forever. Katie traveled to Houston and dedicated herself to the rigorous 6-hour-a-day, 5-day-a-week program, working alongside her occupational therapist, Emily Stevens, MOT, OTR, CSRS. The results were remarkable; within just a few days, her father noticed significant improvements, and Katie herself began to recognize progress in her arm and leg function. In this episode of the Stroke Institute's podcast, Stroke Busters, she shared her daily struggles while also expressing her hopes to empower other survivors to find their voice and advocate for the support and resources they need to thrive. __________________ At the Stroke Busters Podcast, we're on a mission to decode the complexities of strokes, those unexpected disruptions in brain blood flow that can change lives in an instant. Our team of experts, affectionately known as the Stroke Busters, is committed to exploring new frontiers in stroke science, clinical excellence, and public awareness. Each episode will bring you captivating conversations with top physicians, researchers, and courageous survivors, offering valuable perspectives on cutting-edge research, transformative therapies, and inspiring tales of resilience in the face of adversity. Get ready to expand your knowledge and be inspired by the incredible work being done in the world of stroke care. This is the Stroke Busters Podcast, where we break barriers, ignite curiosity, and empower change. ____ StrokeBusters, a Podcast Presented by: The Institute for Stroke and Cerebrovascular Disease at the University of Texas Health Science Center at Houston (UTHealth) or “Stroke Institute Genre: Medicine uth.edu/stroke-institute About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news in stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many who are experts in their field, to discuss their practice, cutting-edge research and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs.

Welcome back to the Neurophilia Podcast! In today's episode, we are joined by the podcast legend himself, Dr. Jim Siegler to discuss vascular neurology.  The field of vascular neurology has had incredible advancements within the past few decades through thrombolytics/mechanical thrombectomy and has seen increased public awareness and accessibility to stroke care. As a result of this, vascular neurology training is consistently among the top fellowships pursued by graduating residents.  Listen to this episode to hear more about the subspecialty of vascular neurology!Dr. Jim Siegler: After obtaining his bachelor's degrees in Neuroscience and History of Science, Medicine, and Technology at Johns Hopkins University, Dr. Jim Siegler completed his medical education at Tulane University School of Medicine in New Orleans. He then completed his adult neurology residency and vascular neurology fellowship at UPenn. He currently serves as the Inpatient Medical Director and Director of the Comprehensive Stroke Center at the University of Chicago. Dr. Siegler's research interests include atherosclerotic disease, perfusion imaging, and eligibility of neurointervention for acute intracranial occlusion for which he has published more than 200 peer-reviewed publications. Dr. Siegler is also a passionate medical educator; he is well-known for previously producing an independent podcast titled BrainWaves  a well as the official podcasts for the Neurocritical Care Society, American Academy of Neurology, American Neurological Association podcast ANA Investigates, but more recently he serves on the e-learning subcommittee of the AAN and helps produce their NeuroBytes, and he serves on the digital strategy team for journal Stroke: Vascular and Interventional Neurology where you might have heard his voice on their podcast, ACCESS. Follow Dr.  Jim Siegler on Twitter @JimSieglerFollow Dr.  Nupur Goel on Twitter @mdgoelsFollow Dr.  Blake Buletko on Twitter @blakebuletkoFollow the Neurophilia Podcast on Twitter and Instagram @NeurophiliaPodSupport the show

Welcome to the Stroke Busters Podcast! I'm your host, Amy Quinn, and I'm thrilled to take you on a journey into the fascinating world of stroke research and innovation. Join me as we delve into the latest breakthroughs and insights from the Institute for Stroke and Cerebrovascular Diseases at UTHealth Houston. At the Stroke Busters Podcast, we're on a mission to decode the complexities of strokes, those unexpected disruptions in brain blood flow that can change lives in an instant. Our team of experts, affectionately known as the Stroke Busters, is committed to exploring new frontiers in stroke science, clinical excellence, and public awareness. Each episode will bring you captivating conversations with top physicians, researchers, and courageous survivors, offering valuable perspectives on cutting-edge research, transformative therapies, and inspiring tales of resilience in the face of adversity. Get ready to expand your knowledge and be inspired by the incredible work being done in the world of stroke care. This is the Stroke Busters Podcast, where we break barriers, ignite curiosity, and empower change. Today, we are honored to have with us a distinguished guest who brings over 20 years of invaluable research experience to the field of stroke care. Starting her journey at MD Anderson Cancer Center and Baylor College of Medicine, she has made significant contributions to neurology and stroke research at Texas Oncology and currently at UT Health. A native Houstonian, she not only excels in her professional endeavors but also embraces an active lifestyle. She has conquered numerous marathons, 10k's, and 5k's, showing her determination and resilience. From MUD runs to step aerobics and trampoline classes, she embodies the importance of physical wellness. Beyond her professional and athletic achievements, our guest is deeply committed to community service. She actively participates in health fairs, community outreach programs, and prevention events, demonstrating her dedication to giving back and improving public health. Join me in welcoming our esteemed guest, a passionate researcher, an avid athlete, and a devoted community advocate. Welcome to the show! ____ StrokeBusters, a Podcast Presented by: The Institute for Stroke and Cerebrovascular Disease at the University of Texas Health Science Center at Houston (UTHealth) or “Stroke Institute Genre: Medicine About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news in stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many who are experts in their field, to discuss their practice, cutting-edge research and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs.

Welcome back to Stroke Busters where we bring you groundbreaking research and expert insights from the Institute for Stroke and Cerebrovascular Diseases at UTHealth Houston. Our team is committed to unraveling the mysteries surrounding strokes, those unexpected interruptions to the blood flow in the brain that can have life-altering consequences. Our team of experts, or as we like to call them Stroke Busters, is dedicated to pushing the boundaries of stroke research, clinical care, and public awareness. Each episode of the Stroke Busters Podcast will feature engaging conversations with leading physicians, researchers, and survivors, providing valuable insights into the latest advancements in stroke science, innovative treatments, and inspiring stories of triumph over adversity. Today, we were honored to chat with our special guest, a true luminary in the world of neurology and health disparities research. Dr. Lewis Morgenstern, a Professor of Neurology, Epidemiology, Emergency Medicine, and Neurosurgery at the University of Michigan Medical School and School of Public Health. Dr. Morgenstern has been at the forefront of groundbreaking research, serving as the Principal Investigator of the NIH-funded Brain Attack Surveillance in Corpus Christi (BASIC) project since 1999. With over 130 original, peer-reviewed manuscripts under his belt, his expertise spans health services clinical trials, stroke epidemiology, and clinical studies of intracerebral hemorrhage. We were able to ask Dr. Morgerstern a few more questions following his Grand Rounds presentation for medical students and faculty at the McGovern Medical School in Houston, TX,  with our host, Dr. Carlos De Garza. ______ StrokeBusters, a Podcast  Presented by: The Institute for Stroke and Cerebrovascular Disease at the University of Texas Health Science Center at Houston (UTHealth) or “Stroke Institute  Genre: Medicine    About  StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news in stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many who are experts in their field, to discuss their practice, cutting-edge research and medical care.  Who We Are  The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation.  Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs.  Our Podcast Audience  Our podcast content is targeted to stroke trainees (fellows, residents, medical students); however, we receive a wide range of listeners primarily in their 20's to 40's with moderate to advanced levels of education.  Contact  For more information or if you have any questions, please contact us at info.uthiscd@gmail.com 

Dr. Natalia Rost is the associate director of the Comprehensive Stroke Center of Massachusetts General Hospital and discussed the disease and how to lower your risk.

There are a number of risks for strokes, some modifiable. Advancements in treatment have saved countless lives. David Stone, MD, a vascular neurologist at Sarasota Memorial discusses what can be done to prevent strokes and what it means for SMH-Sarasota to be a recognized Comprehensive Stroke Center.You can also watch the video recording on our Vimeo channel here.For more health tips & news you can use from experts you trust, sign up for Sarasota Memorial's monthly digital newsletter, Healthe-Matters.

The Future of Cardiac Monitoring and Anticoagulation After Ischemic Stroke and TIA w/ Luciano A. Sposato, MD MBA FRCPC Professor of Neurology, Western University Host: Jacob Sambursky, MD Welcome back to Stroke Busters, a podcast presented by the Institute for Stroke and Cerebrovascular Disease at UTHealth Houston. On this show, we connect with leaders in stroke care, research, community, and academia. We're not just active; we're at the forefront—recognized as the first Comprehensive Stroke Center in the state and pioneers in launching the nation's first Mobile Stroke Unit. I'm Amy Quinn, Communications Director for the Stroke Institute, and proud to bring you another episode to share expert insights, groundbreaking research, and real stories from the forefront of medicine.  It's that time again for a Grand Rounds follow-up interview! Dr. Luciano Sposato, Professor of Neurology, at Western University joined us for Grand Rounds at the McGovern Medical School here in Houston, TX, and presented on The Future of Cardiac Monitoring and Anticoagulation After Ischemic Stroke and TIA.  Following his Grand Rounds presentation for trainees and students, one of our Stroke Fellows Jacob Sambursky, stuck around to ask some more in-depth questions. As always, Ideas and opinions expressed on this podcast are our own and are not a substitute for expert medical advice. Always contact your doctor before starting any program or therapy to make sure you are getting the best care, tailored to your unique situation.   UTHealth Stroke is on social media! Follow us on Twitter, LinkedIn, Instagram, and Facebook at UTHEALTHSTROKE to stay updated on upcoming episodes, and share with colleagues, friends, and family.  For updates and the latest news on the Stroke Institute, go online to uth.edu/stroke-institute

Rebecca Karb, MD, PhD, Co-Director, Comprehensive Stroke Center, Rhode Island Hospital, Attending Physician, Emergency Medicine, Rhode Island Hospital and House of Hope's Director of Outreach Sara Melucci join the show to discuss Lifespan's Street Outreach Program which seeks to provide direct care to vulnerable Rhode Islanders. Support the show

In today's episode, Adrienne took a quick trip to Chicago to catch up with her Ommie, Hannah.  Hannah was 29 years old when she suffered a major stroke and subsequently was diagnosed with epilepsy. Her life shifted dramatically as she learned to cope with life after stroke. Follow Hannah on social media: @hannahpinteaSupport Hannah and the Epilepsy Foundation of Greater ChicagoClick here to learn more about the Comprehensive Stroke Center at Northwestern Memorial HospitalFollow us on TikTok:https://www.tiktok.com/@yogachangedFollow us on Instagram:https://instagram.com/yogachanged?igshid=YmMyMTA2M2Y=For more, go to https://howyogachangedmylife.com Wanna be on the show? Click here to fill out our guest info form or drop us a email at yogachanged@gmail.com

Welcome to an exciting episode of STroke Busters! Today, we're thrilled to introduce you to Dr. Wondwossen Tekle, who recently delivered a groundbreaking Vascular Neurology Grand Rounds presentation at McGovern Medical School. Dr. Tekle shares his incredible journey of pioneering Ethiopia's very first Stroke and Neurointerventional Program. Join our UTHealth Houston Vascular Neurology fellow, Carlos De La Garza, as he delves deep into Dr. Tekle's inspiring story. Learn how this innovative program is transforming healthcare in Ethiopia and making a global impact. If you're passionate about stroke care, neurointervention, or global healthcare initiatives, you won't want to miss this captivating conversation. Tune in now and be inspired by Dr. Tekle's extraordinary work! Don't forget to like, subscribe, and share this episode with your friends and colleagues. Together, let's spread awareness about this vital mission and advance stroke care worldwide. ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: linkedin.com/company/uthealth-stroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at ⁠info.uthiscd@gma⁠il.com

Today's guest is Dr. James Grotta, who after joining UT Houston faculty in 1979, he established the UT Houston Stroke Program and developed its NIH funded fellowship training program. He has been continuously funded to carry out translational research in acute stroke treatment, and played a leading role in many clinical research studies, including the NINDS TPA Stroke Study. In 2013, Dr. Grotta stepped down as department chair and moved his practice to Memorial Hermann Hospital to lead the Mobile Stroke Unit Consortium, the nation's first Mobile Stroke Unit to deliver TPA and other stroke therapies wherever the stroke occurs Dr. Grotta joined us for a Vascular Neurology Grand Rounds and stuck around to record this episode with one of our Vascular Neurology Fellows, Mohammad Rauf  to answer some more questions, so that we can share more of his insight and research.  ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: linkedin.com/company/uthealth-stroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at ⁠info.uthiscd@gma⁠il.com

Today's guest is Dr. Ameer Hassan, a triple board-certified neurologist who specializes in stroke, and is Head of the Neuroscience Department and a Professor of Neurology and Radiology at the University of TX Rio Grande Valley Dr. Hassan joined us for a Vascular Neurology Grand Rounds and stuck around to record this episode with one of our Vascular Neurology Fellows, Danish Kherani to answer some more questions so that we can share more of his insight and research.  ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: linkedin.com/company/uthealth-stroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at ⁠info.uthiscd@gma⁠il.com

Stroke Busters is a podcast presented by the Institute for Stroke and Cerebrovascular Disease at UTHealth Houston in Houston, TX. The purpose of this podcast is to bring you the latest news and discussion in stroke care, research, community, and academia. Today's guest is Dr. Patrick Key, a non-invasive board-certified clinical cardiologist with clinical interests in clinical lipidology, preventive cardiology and non-invasive cardiovascular imaging. His Ph.D. research focuses on the metabolism of high-density lipoproteins (aka good cholesterol). He has an active research program in molecular imaging of atherosclerosis and targeted drug delivery using novel nanoparticles and intravascular devices. He is a member of the National Lipid Association and is up to date with the contemporary management of various lipid disorders. He runs a Level 2 Lipid Clinic and Preventive Cardiology Clinic at the UT Professional Building.  Dr. Kee joined us for Stroke Grand Rounds and stuck around to record this episode with one of our Vascular Neurology Fellows, Jerome Jeevarajan to answer some more questions, so that we can share more of his insight and research. ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: linkedin.com/company/uthealth-stroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

Akron Beacon Journal consumer columnist and medical reporter Betty Lin Fisher speaks with Dr. Susana Bowling, the medical director of the Neuroscience Institute at Summa Health in Akron and Summa's Comprehensive Stroke Center. During this Healthy Actions audio column, we discuss the new BE FAST stroke acronym and how to spot signs and symptoms.

Akron Beacon Journal consumer columnist and medical reporter Betty Lin Fisher speaks with Dr. Susana Bowling, the medical director of the Neuroscience Institute at Summa Health in Akron and Summa's Comprehensive Stroke Center. During this Healthy Actions audio column, we discuss the new BE FAST stroke acronym and how to spot signs and symptoms.

Dr. Fan Caprio, Neurologist and Medical Director of the Comprehensive Stroke Center at Northwestern Memorial Hospital, joins John Williams to discuss what Northwestern is doing to provide stroke care. Dr. Caprio talks about the main types of strokes, how you can recognize the signs of a stroke, what the risk factors are for a stroke, […]

Dr. Fan Caprio, Neurologist and Medical Director of the Comprehensive Stroke Center at Northwestern Memorial Hospital, joins John Williams to discuss what Northwestern is doing to provide stroke care. Dr. Caprio talks about the main types of strokes, how you can recognize the signs of a stroke, what the risk factors are for a stroke, […]

Dr. Fan Caprio, Neurologist and Medical Director of the Comprehensive Stroke Center at Northwestern Memorial Hospital, joins John Williams to discuss what Northwestern is doing to provide stroke care. Dr. Caprio talks about the main types of strokes, how you can recognize the signs of a stroke, what the risk factors are for a stroke, […]

It's important that someone suffering a stroke is treated quickly to save their lives. Sarasota Memorial is a comprehensive stroke center to provide the most advanced interventions for patients, and after surviving a stroke, Wanda Jackson, outpatient care coordinator at SMH, helps to connect patients and families with the resources needed in the community to recover both mentally and physically.You can also watch the video recording on our YouTube channel here.For more health tips & news you can use from experts you trust, sign up for Sarasota Memorial's monthly digital newsletter, Healthe-Matters.

Among several highlights of the recent International Stroke Conference was new evidence supporting endovascular thrombectomy for patients with so-called “large core” ischemic strokes. In current practice, thrombectomy is considered for patients with occlusions of the internal carotid or middle cerebral artery who are less than 24 hours since the last known well and have a small “core” of ischemia on non-contrast head CT or CT or MR perfusion imaging -- in other words, there's radiographic evidence that only a small core of the brain has suffered permanent injury and a larger penumbra of tissue can be saved. SELECT-2 is a multicenter randomized controlled trial that examined whether patients with LARGE cores of ischemic tissue could ALSO benefit from thrombectomy. On our show today we have SELECT-2 principal investigator Dr. AM-rou sou-RAJ, who is also Professor of Neurology at Case Western Reserve University School of Medicine. He was interviewed by Dr. Michelle Johansen, vascular neurologist at Johns Hopkins University, about what the study results might mean for stroke care -- and stroke imaging -- going forward. Series 4, Episode 6. Featuring: Guest: Amrou Sarraj, MD FAHA, Professor of Neurology, Case Western Reserve University School of Medicine, George M. Humphrey II Endowed Chair, University Hospitals Neurological Institute, Director, Comprehensive Stroke Center and Stroke Systems, University Hospitals Interviewer: Dr. Michelle Johansen, Johns Hopkins Medicine Producer: Dr. Joseph Carrera, University of Michigan Disclosures: Dr. Sarraj discloses the following relationships: SELECT2 principal investigator - funded by Stryker Neurovascular with research grant to University Hospitals Cleveland Medical Center and UT McGovern Medical School SELECT principal investigator - funded by Stryker Neurovascular with research grant to UT McGovern Medical School Member, Speaker bureau and advisory board - Stryker Neurovascular Provided advisory services to AstraZeneca, Genentech and Lumosa Theraputics

We have another Grand Rounds follow up interview for you today, and a special one at that! Dr. Jared Chen has joined the Stroke Institute here at UTHealth Houston and we were so thankful not only for his time spent on his Grand Rounds presentation, but for sticking around for an in-depth look into his research and new faculty position. One of this year's Stroke Institute fellows, Mohammad Rauf, discussed Intracerebral Hemorrhage Therapies with Dr. Chen, past, present, and future, and we hope you enjoy, and share with colleagues. ____________________________________ Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

It's that time again for a Grand Rounds follow-up interview! Dr. Andrew Southerland, Associate Professor in the division of vascular neurology, departments of neurology and public health sciences at the University of Virginia Health. Our Stroke Fellow, Mohammad Rauf, interviewed Dr. Southerland following his Grand Rounds presentation, "Augmenting Clinical Diagnosis in Stroke" at McGovern Medical School to ask some more in-depth questions. __________ The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ Host: Mohammad Rauf, Vascular Neurology Fellow, UTHealth Houston Stroke Institute Guest: Dr. Andrew Southerland | https://uvahealth.com/findadoctor/profile/andrew-m-southerland Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

This week Bobbi Conner talks with Dr. Parneet Grewal about healthy diet and lifestyle modifications to lower stroke risk. Dr. Grewal is an Assistant Professor and neurologist in the Comprehensive Stroke Center at MUSC.

On Episode 21 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the October 2022 issue of Stroke: “Oral Contraceptives, Hormone Replacement Therapy, and Stroke Risk” and “Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage.” She also interviews Dr. Shadi Yaghi about his article “Direct Oral Anticoagulants Versus Vitamin K Antagonists in Cerebral Venous Thrombosis.” Dr. Negar Asdaghi:         Let's start with some questions. 1) Do hormone replacement therapies or oral contraceptives increase the risk of stroke? And if yes, does the age of the individual or the duration of therapy modify this risk? 2) Should survivors of intracranial hemorrhage who have atrial fibrillation be treated with antithrombotic therapies for secondary prevention of stroke? 3) And finally, what is the anticoagulant of choice for treatment of cerebral venous sinus thrombosis? We have the answers and much more in today's podcast as we continue to bring you the latest in cerebrovascular disorders. You're listening to the Stroke Alert Podcast, and this is the best in Stroke. Stay with us. Welcome back to another amazing issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine, and your host for the monthly Stroke Alert Podcast. The October issue of Stroke covers a number of timely topics. As part of our October Literature Synopsis, we have a nice paper by Dr. Farida Sohrabji and colleague, which summarizes three recently published animal studies to evaluate the association between small vessel ischemic injury and either development of Parkinsonism or the future risk of Parkinson's disease. These studies looked at how ischemia, specifically involving the lenticulostriate arteries, can modulate the nigrostriatal dopaminergic pathway and ultimately lead to Parkinsonism. As part of our Original Contributions, we have the results of a small randomized trial out of Korea, which was led by Dr. Yun-Hee Kim from Sungkyunkwan University School of Medicine in Seoul, where we learned that doing 20 sessions of transcranial direct current stimulation for about 30 minutes for each session at home can improve post-stroke cognition. This was found to be specifically effective in patients with post-stroke moderate cognitive decline. Now, transcranial current stimulation can be given using a handheld device at home, and if truly proven safe and efficacious in larger studies, can dramatically change the landscape of stroke recovery in cognitive rehabilitation. I encourage you to review these articles in addition to listening to our podcast today. Later in the podcast, I have the great pleasure of interviewing Dr. Shadi Yaghi from Brown University. Shadi will walk us through a systematic review and meta-analysis of published studies to compare the safety and efficacy of direct oral anticoagulants to that of vitamin K antagonists in patients with cerebral venous sinus thrombosis. Our devoted Stroke Alert Podcast listeners recall that we did cover this topic in our March podcast when we reviewed the results of ACTION-CVT, a multicenter international study that was led by none other than Shadi himself. I'm delighted to have him as a guest on my podcast today to talk more about the seminal study and all things cerebral venous sinus thrombosis. But first, with these two articles. Millions of women worldwide use exogenous hormones, most commonly in the form of oral contraceptives and hormone replacement therapies. Despite the many different formulations of these drugs that are now available on the market, the two therapies are similar in that both combined oral contraceptives and hormone replacement therapies, or HRTs, contain various dosage of estrogen and progestin. Now, the principal difference between them being that the hormone contents of oral contraceptives are at high enough dosage to prevent ovulation, whereas hormone replacement therapies are considered more physiological as their aim is to return post-menopausal hormone levels to what they were before menopause. Well, by now, you must wonder how is any of this even relevant to vascular neurology? Well, the answer lies in the close relationship between hormonal therapies and stroke. But before we get to that, we have to review a few things. First of all, it's long been known that the endogenous estrogen has strong and protective effects on the arteries. It promotes vasodilation and cell survival of the endothelial layer. It increases the endothelial mitochondrial efficiency and stimulates angiogenesis. In other words, endogenous estrogen is good for vascular health. And in fact, that's why we think that premenopausal women, in general, are at a lower risk of stroke as compared to their age and vascular risk factors–matched male counterparts. And to make things even better for estrogen, there's enough evidence to suggest that exogenous estrogen also does all of these good things for the endothelium. So, why are we even talking about an increased risk of stroke associated with use of hormonal therapies? The problem is, we have to remember that exogenous estrogen also does other things. It can increase the blood concentration of procoagulants, which, in turn, can increase the risk of thromboembolism, especially venous thrombosis. But there's still a lot of unknown on this topic. For instance, the majority of the prior research on the topic involves postmenopausal women using hormonal therapies. Some of that research has actually suggested that HRTs may be protective against vascular events, while others showed the opposite. Well, we know that a majority of oral contraceptive users are actually much younger and use these medications premenopausal. So, there seems to be a lot of gaps in our current knowledge on the simple question of whether or not oral contraceptives and hormonal replacement therapies do, in fact, increase the risk of stroke or not. In the current issue of the journal, a group of researchers led by Drs. Therese Johansson, Torgny Karlsson, and Åsa Johansson from the Department of Immunology, Genetics and Pathology at Uppsala University in Sweden set out to fill some of these gaps with their study titled, "Oral Contraceptives, Hormone Replacement Therapy, and Risk of Stroke," as part of a large UK Biobank population-based cohort. Just a bit about the UK Biobank. This was a large population-based cohort from 2006 to 2010 that included over 500,000 residents of the United Kingdom between the ages of 37 and 73. Participants at the time of enrollment would have extensive information collected from them through questionnaires, interviews, health records, physical measures, as well as some imaging and biological samples. Data on each participant was collected from the time of their birth all the way to the day of assessment, which is interesting, because the day of assessment would then count as the end of the follow-up for each participant. Now, for the current study, they included over 250,000 women of White race in whom information required for the study on whether or not they use hormonal therapies, duration of treatment, age at the time of exposure was available. And just a quick comment about their methodology. They analyzed their cohort once for oral contraceptive use and once for HRT use and compared each group to a reference group of either women who never used their set therapy or the number of years they contributed to the study prior to initiating that set treatment. So, for instance, if a person started using oral contraceptives at the age of 21, all of the years that she contributed to the study before that age would count as non-exposed user years and were included in the control cohort. So now, on to their findings. A total of 3007 stroke diagnosis of any type were identified prior to the initial visit to the assessment center, which, as we mentioned, was the end of the follow-up in the study. Of these, 578 were ischemic strokes, 177 intracerebral hemorrhage, and 478 were subarachnoid hemorrhages. But as expected for any large cohort, over half of total strokes were self-reported as stroke of any type and could not be classified into any of the above subtypes. Now, let's look at the effects of oral contraceptives on the outcome of stroke. Overall of the women included in the study, 81% were classified as oral contraceptive users, while 19% reported never having used oral contraceptives at any point during the study. On the association between oral contraceptive use and the risk of stroke, at first glance, things looked OK. The hazard rates of any stroke for any stroke subtypes were not different between women who had used oral contraceptives as compared to those in the reference group. That's great news. But when they looked deeper, they realized that the odds of development of any stroke was actually quite high during the first year after the initiation of oral contraceptives with hazard rate of 2.49 for any stroke, while there was no difference in hazard rates found during the remaining years of use and after discontinuation of oral contraceptive use. So, meaning that there was no lingering effects of oral contraceptives on increased risk of stroke after the first year or after discontinuing the medication. Now, on to HRTs. In total, 37% of women in the study had initiated HRTs at some point during the study, while 63% had never used this therapy. Here's the bad news. Overall, HRTs did increase the risk of stroke. An approximately 20% increase event rate of any stroke was noted among women who had initiated HRTs as compared to those who had not. When analyzing stroke subtypes, the use of HRTs was associated with increased risk of only the subarachnoid hemorrhage subtypes. We don't know why. Diving deeper, in considering timing of HRT initiation, very similar to what was observed for the oral contraceptives, during the first year after starting the HRTs, the treatment group was twice more likely to suffer from any type of stroke, and the hazard rate was also increased for all three stroke subtypes that were available in the study. But, unlike oral contraceptives, the hazard rate of any stroke remains significantly high even after the first year of use, not just for those who continued HRTs, but sadly, even for those who discontinued the therapy. Though the risk remained high, the hazard ratio declined over time as we went further away from the first year when treatment was initiated. So, bottom line, if women had initiated HRTs at some point in their life, the hazard risk of any stroke increased significantly in the first year. That hazard risk did decline over time, but it always remained significantly higher than non–HRT users. Now, what about timing of treatment in relation to the onset of menopause? Is the risk of stroke any different if women start on HRTs prior to or after their menopause? The answer is no. Initiation of HRTs was associated with an increased hazard rate of any stroke if it was started pre- or postmenopausal, but the risks were higher if the treatment was started prior to menopause. So, in summary, this large population-based cohort has truly given us some very important practical findings. We learned that both oral contraceptives and hormone replacement therapies do, in fact, increase the risk of stroke, an effect that was most notable in this study in the first year after initiation of both of these therapies, and in the case of oral contraceptives, was just actually limited to that one year alone. Why does this happen? I guess the easy answer is that these drugs, as we noted earlier, have an immediate prothrombotic effect, which gradually weakens over time. That's one plausible explanation, but for instance, why HRTs increase the risk of subarachnoid hemorrhage is something we can't explain based on the prothrombotic effects of HRTs. So, we have to come back to the vessels, the impact of hormone therapies and estrogen specifically on the blood vessels, on the endothelial cells, the potential increase in blood pressure, especially early on in the course of treatment with these medications. And also, we have to think about the role these drugs may play in increasing inflammatory markers, providing a more suitable milieu for accelerated atherosclerosis, as to why these associations were noted in this study. And it's fair to say that we need more research on this topic in the future. One challenging scenario that we commonly face in our daily practice is deciding whether or not we should resume antithrombotics in patients with atrial fibrillation who have survived an intracranial hemorrhage. The majority of intracranial hemorrhage survivors with atrial fibrillation actually have a very high CHA2DS2-VASc score, which means that they are actually at a very high risk of future ischemic stroke and systemic embolic events unless they're treated with anticoagulants. On the other hand, the risk of spontaneous intracranial bleeding is substantially higher in a person who has previously suffered from one, let alone if we treat them with anticoagulants. And to make matters worse, we have little evidence from the literature to guide us. So, in the current issue of the journal, in the study titled "Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage," a group of researchers from the UK led by Dr. Deirdre Lane, Professor of Medicine at the University of Liverpool, performed a much needed systematic review and meta-analysis of the available evidence on this subject. I have to say that lately, it seems that we've been covering a few of these reviews in our podcasts, and we are just getting started. In fact, my next paper in today's episode is also a systematic review and meta-analysis. These papers are packed with details, a testament to the work needed to complete them, but I have to say that even summarizing these papers for a podcast has been a bit challenging. So, feel free to put me on pause, go get some coffee, and let's power through this one together. For their methods, they used the usual search engines looking for papers that included adults over the age of 18 with atrial fibrillation who had survived a non-traumatic spontaneous intracranial hemorrhage of any size, any type, and any location, be it lobar, brain stem, deep, cerebellar, subdural, epidural, or subarachnoid hemorrhage. And very importantly, they included even those with evidence of microbleeds on neuroimaging. The intervention of interest was either long-term oral anticoagulation or antiplatelet therapy versus no antithrombotic use for the following three outcomes of interest: number one, recurrent thromboembolic events; number two, recurrent intracranial hemorrhage; and number three, all-cause mortality. Just a quick note that for this analysis, they excluded studies that looked at either short-term anticoagulation or non-oral anticoagulation use for any reason that was given to the patient other than for secondary prevention of stroke. For example, if a patient suffered from a pulmonary embolism and was treated with IV heparin or, for a short period of time after that, with oral anticoagulation, those patients or those studies were excluded from this meta-analysis. So, with this criteria, they pulled over 4,000 citations and abstracts, and finally included 20 papers that were published between 2015 and 2021 for a total of over 50,000 participants for this meta-analysis, very nice sample size. Most of the papers included were observational cohorts, but in addition, we had two small randomized trials, and I want to take a moment and review these trials for our listeners. The first one was a small noninferiority pilot trial out of the UK, the SoSTART trial, that looked at any anticoagulant versus either antiplatelet therapy or no antithrombotics in this population, and the other trial was the Phase 2 trial, the APACHE-AF, that studied apixaban versus no anticoagulation after anticoagulant-associated intracerebral hemorrhage. A reminder that both of these trials were published in Lancet Neurology in 2021. And before we move on to the findings of the meta-analysis, it's worth noting that they had included a mix of patients, some were oral anticoagulant–naive, and some had developed their index intracranial hemorrhage while already on treatment with anticoagulants or antiplatelet therapies. OK, now on to their findings, as mentioned, we're going to review three outcomes of recurrent thromboembolism, recurrent intracranial hemorrhage, and all-cause death for the following three groups: group one, oral anticoagulant therapy versus no therapy; group two, oral anticoagulation therapy versus either antiplatelet treatment or no therapy; group three, comparing new oral anticoagulants versus warfarin. So, for the first outcome of recurrent thromboembolic events in group one, when comparing oral anticoagulant therapy to no therapy, the study showed a significant reduction in thromboembolic events in favor of oral anticoagulation compared to no therapy. That's great news. Next, analysis of the studies that compared oral anticoagulation versus either antiplatelets or no therapy didn't show the same difference in prevention of embolic events in favor of either groups. Actually, no difference was noted between the two groups. Number three, now, in terms of comparing NOACs to warfarin, three studies had the information on this comparison, and they reported a significant reduction in the risk of thromboembolic events with NOAC as compared to warfarin. So, great news for oral anticoagulation overall, and especially for NOACs. Now, on the next outcome. Our second outcome was a recurrent intracranial hemorrhage. Keeping in mind that they included some studies where the outcome was defined as any form of intracranial hemorrhage, meaning they included subdurals, epidurals, etc., and some studies only included the outcome of intracerebral hemorrhage. So, on to the first group, comparing oral anticoagulants to no therapy, the pooled estimate revealed no statistically significant difference between oral anticoagulant–treated patients to those who were not treated with any antithrombotics on the risk of recurrent intracranial hemorrhage. That's great news. Next, on our second group, for the same outcome of recurrent intracranial hemorrhage, comparing oral anticoagulants to either antiplatelet therapy or no treatment, they found that oral anticoagulation was associated with a higher risk of recurrent intracranial hemorrhage as compared to antiplatelets or no therapy. And finally, third group comparing new oral anticoagulants to warfarin for the same outcome, the risk of recurrent intracranial hemorrhage was significantly reduced in patients treated with NOACs as compared to warfarin. And now, we're finally on to our last outcome of the study, which is the outcome of all-cause mortality. So, again back to group one, comparing oral anticoagulants to no therapy, this meta-analysis showed a significant reduction in all-cause mortality rate associated with oral anticoagulation. That's, again, great news. Next group, for the same outcome of mortality, comparing oral anticoagulants to either antiplatelet therapy or no treatment, they found no significant difference in the mortality rates between the two groups. And finally, comparing NOACs to warfarin, the pooled estimate showed that NOACs were associated with a significantly reduced risk of all-cause mortality. Amazing news for NOACs. So, in summary, here's what we learned from this big study. Oral anticoagulation use after intracranial hemorrhage in patients with atrial fibrillation did significantly reduce the risk of thromboembolic events and all-cause mortality without significantly increasing the risk of recurrent intracranial hemorrhage. In general, new oral anticoagulants, or NOACs, are preferred to warfarin as they do prevent embolic events with a lower risk of recurrent intracranial hemorrhage. But, of course, we still have a lot more questions. For instance, would any of the outcomes mentioned above be different in patients with lobar intracerebral hemorrhage, a condition typically associated with amyloid angiopathy, which carries a high risk of development of intracerebral hemorrhage? Also, we have to keep in mind that the majority of the studies included in the meta-analysis were observational. So, there remains an urgent need for a larger randomized trial on this subject, and we have to stay tuned for more research. Cerebral venous sinus thrombosis, or CVST, is an uncommon form of stroke resulting in headaches, seizure, or focal neurological symptoms due to either intracranial hemorrhage or venous ischemic infarcts. The rarity of the disease has made it difficult to study as part of randomized trials, so current treatment guidelines for CVST are consensus-based with much of the recommendations extrapolated from data on treatment of patients with systemic deep vein thrombosis. In general, based on the current evidence, the field agrees that a patient with CVST should be anticoagulated. The decision that is difficult and sometimes inappropriately delayed in the setting of acute hemorrhage in the brain. And not surprisingly, there's significant equipoise around the choice of anticoagulant, duration of therapy, and the role of heroic therapies, especially in the acute setting. Currently, there are a number of ongoing trials to address some of these issues. The direct oral anticoagulants present an attractive alternative to vitamin K antagonists for treatment of patients with CVST. This is partly because of their convenience of use. But how do direct anticoagulants compare in safety and efficacy to the vitamin K antagonists in the setting of CVST is less known. In our March podcast, we reviewed the results of ACTION-CVT, which was a multicenter international study that compared the safety and efficacy profile of the direct oral anticoagulants to that of warfarin in routine practice. The study included over a thousand imaging-confirmed CVST patients from multiple centers in the US, Italy, Switzerland, and New Zealand. And if you missed it, no worries at all. We're here to review some of the results again, as in this issue of the journal, many of the ACTION-CVT investigators, led by Dr. Shadi Yaghi, present the results of a systematic review and meta-analysis comparing the safety and efficacy of DOACs, or direct oral anticoagulants, to that of vitamin K antagonists. I'm joined today by Dr. Yaghi himself to discuss ACTION-CVT and the current meta-analysis. Dr. Yaghi is a Director of Vascular Neurology at Lifespan and Co-Director of Comprehensive Stroke Center and a Director of Research at the Neurovascular Center at Rhode Island Hospital. Good afternoon, Shadi, and welcome to our podcast. Dr. Shadi Yaghi:               Good afternoon, Dr. Asdaghi. Thank you so much for having me. Dr. Negar Asdaghi:         Thank you. And please call me Negar. Congrats on the paper. Before we talk about the meta-analysis, can you please remind us of the results of ACTION-CVT and why the systematic review, in your opinion, was an important next step to that effort? Dr. Shadi Yaghi:               Thank you so much for having me and for bringing up ACTION-CVT. So ACTION-CVT is a real-world multicenter international study that used real-world observational data to compare the safety and efficacy of direct oral anticoagulants to vitamin K antagonists in patients with cerebral venous thrombosis. The reason why we did ACTION-CVT was, as you know, cerebral venous thrombosis is a rare disease, and it's hard to have large studies that would be powered enough to compare the safety and efficacy of direct oral anticoagulants to vitamin K antagonists. So, most of the studies that were done are small, retrospective. There's one randomized controlled trial, but most of them are underpowered to detect the difference between the two groups. So, we decided to do a large-scale international multicenter study using real-world data to compare the safety and efficacy of both. Dr. Negar Asdaghi:         OK, so we're glad you did. Let's start with the methodology of the current meta-analysis. Can you please give us an overview of the inclusion criteria for selection of the papers and the intervention and outcomes that you were interested in? Dr. Shadi Yaghi:               Of course. So, this is a systematic review and meta-analysis that included studies comparing direct oral anticoagulants to vitamin K antagonists in patients with cerebral venous thrombosis. The studies needed to have the two groups included, the direct oral anticoagulants and vitamin K antagonists, and they need to include at least one of the outcomes in our study to compare this outcome between the two groups. In addition, we included articles published in English, and we also included papers that had five patients or more in each group. Dr. Negar Asdaghi:         Perfect. So just recap for our listeners, in order to have been included in the meta-analysis, the paper had to have a reasonable number of patients, and you put that reasonable at the number five, and also they had to have at least one of the outcomes of interest reported in their papers. And those outcomes were either recurrent venous thromboembolism or recanalization rates. Right? Dr. Shadi Yaghi:               Correct. Yes. Dr. Negar Asdaghi:         Perfect. So with that, how many papers did you have to go through to come up with the current number of papers included? Dr. Shadi Yaghi:               That's a great question. We had a little over 10,000 papers, and then we went through a screening process. We used this tool that was developed by Brown University. It's called Abstrackr, and what you do is, we did the search and using several databases like PubMed, Cochrane, and then we included all these studies. We uploaded them in Abstrackr, and Abstrackr was utilized to be able to review all these abstracts and select studies that may or will probably qualify and then go through the studies and details that would qualify. So, we had about 10,000 studies with the initial search, and we had two reviewers go through each abstract, and from these 10,665, we excluded 10,411, and that left us with 254 studies. And then we went through these 254 studies in details. And then finally, we had 19 studies included that met our inclusion/exclusion criteria. And these 19 studies included three randomized control trials and 16 observational studies. Dr. Negar Asdaghi:         Incredible effort. So, three randomized trials in this meta-analysis and 16 observational studies. I think we're very ready to hear the primary outcomes. Dr. Shadi Yaghi:               Yeah, so, the primary outcomes were recurrent venous thrombosis, and that included recurrent venous thromboembolism like peripheral DVTs or PEs, for example, and including recurrent cerebral venous thrombosis. And we know that most of the events are recurrent VTEs, not CVTs, like probably about two-thirds to three-quarters were VTEs, and a third to a quarter were CVT. And then the other efficacy outcome is venous recanalization on follow-up imaging. And we found that direct oral anticoagulants and warfarin were not significantly different in the primary efficacy outcomes. Dr. Negar Asdaghi:         Thank you. I just want to repeat this for our listeners. So, you mentioned some important information here. First one was the fact that about three-quarters of recurrent events were actually systemic thromboembolic events rather than cerebral thromboembolism. So, an important outcome to keep in mind for our practicing physicians. And the fact that DOACs did the same as compared to vitamin K antagonist. So, I think you can already guess my next question, and that is, was there any compromise on the safety profile when using DOACs as compared to vitamin K antagonists in this meta-analysis? Dr. Shadi Yaghi:               Thank you. That's a great question. In ACTION-CVT, we found that there was a lower risk of major hemorrhage with direct oral anticoagulants compared to vitamin K antagonists. In this systematic review and meta-analysis, we didn't find a significant difference, but there were fewer events in patients treated with direct oral anticoagulants versus vitamin K antagonists. This did not reach statistical significance, but if you look at the raw data, it's kind of along the same lines as ACTION-CVT, so the risk of major hemorrhage was about 3.5% with warfarin, and that was about 2% with direct oral anticoagulants. Dr. Negar Asdaghi:         So, again, very important finding, and I want to repeat this for our listeners. So, important finding number one was that there was a superiority in favor of DOACs that you found in terms of a reduced risk of intracerebral hemorrhage in ACTION-CVT. You didn't find this superiority in the meta-analysis, but there was sort of a hint to perhaps lower risk of intracerebral hemorrhage in patients that were treated with DOACs. Did I get that right? Dr. Shadi Yaghi:               Yes, that is correct, and in addition, also major hemorrhage in general, and that included also ICH. Dr. Negar Asdaghi:         Oh, OK, so not just intracranial, but systemic hemorrhages as well. All right. Very good. So, I think my next question would be, why do you think that DOACs have a lower chance of causing hemorrhage? Dr. Shadi Yaghi:               Yeah, that's a really good question. This is not unexpected with DOACs as opposed to vitamin K antagonists. We saw these same trends in patients with atrial fibrillation. We saw improved bleeding profiles with direct oral anticoagulants as compared to vitamin K antagonists. And the risks were along the same lines that we found in patients with cerebral venous thrombosis in ACTION-CVT. Also in the VTE trials as well, there was also reduced bleeding complications with direct oral anticoagulants as compared to vitamin K antagonists. So, it was kind of reassuring to see the same results in patients with cerebral venous thrombosis. Dr. Negar Asdaghi:         Perfect, so kind of expected based on what we know from treatment of systemic conditions with DOACs. The next question I have for you is that in routine practice, treatment of cerebral venous sinus thrombosis almost always starts parenterally with either unfractionated heparin or low molecular weight heparin and then we switch to an oral agent. In the observational studies, did you find any differences in terms of timing of this switch or characteristics of the patients in whom vitamin K antagonists were chosen over direct oral anticoagulants? Dr. Shadi Yaghi:               Thank you very much. Most of the studies did not report these details. I think the one study, off the top of my head, that does report the differences in characteristics between the two groups is RESPECT-CVT. That's the randomized controlled trial comparing dabigatran to vitamin K antagonists. In this study, there was a treatment with parenteral anticoagulation for several days, I think seven to 14 days, prior to transitioning to oral anticoagulation. And this is generally my practice. I typically would treat patients with at least seven days or so parenteral anticoagulation, and once they're clinically stable, then I would transition them to oral anticoagulation, either vitamin K antagonists or direct oral anticoagulant. Dr. Negar Asdaghi:         And I think my next question is along the lines of this question as well. We have several direct oral anticoagulants now available on the market. What was the most common DOACs used for treatment of CVST in these studies, and did you note a preference for the use of any particular agent over others? Dr. Shadi Yaghi:               Thank you so much for the question. Anti-Xa inhibitors were much more common than dabigatran, and the anti-Xa inhibitors most commonly used were apixaban and rivaroxaban. It's in line with what we saw in ACTION-CVT as well, although most of the randomized controlled trials or the largest randomized controlled trial, RESPECT-CVT, used dabigatran, but overall people have been using anti-Xa inhibitors, more particularly apixaban, which was also in line with what we saw in ACTION-CVT. Dr. Negar Asdaghi:         But I think it's fair to say that we don't really have data on superiority of one over others. Is that fair? Dr. Shadi Yaghi:               Yes, that is correct. Dr. Negar Asdaghi:         OK, and so now, where are we at in terms of the future of studies on this topic? We have one ongoing randomized trial now? Dr. Shadi Yaghi:               Yes, we have one randomized controlled trial ongoing, and this is the SECRET trial, and it's looking at rivaroxaban versus vitamin K antagonists in patients with cerebral venous thrombosis. There's another study, it's a prospective observational study that's called the DOAC-CVT study. It's an international study also looking at real-world data prospectively to see if there's a difference in outcomes between the two groups. Dr. Negar Asdaghi:         So, we look forward to the results of those studies. Shadi, a follow-up question I have on this topic is, how long should a duration of therapy be in idiopathic cases of cerebral venous sinus thrombosis? Dr. Shadi Yaghi:               Thank you so much for this question. So, it's unknown at this point for how long should we treat. The key things from the treatment are first achieving venous recanalization, and second is preventing another venous thromboembolic event from happening. So, regarding the venous recanalization, studies have shown that there's not a lot of recanalization beyond four months of treatment. So, a lot of the recanalization really happens early, and continuing anticoagulation beyond the six-months interval, for example, in order to achieve further venous recanalization probably has limited utility. And the second important reason why we treat patients with anticoagulation is also to reduce the risk of a recurrent venous thromboembolic event or cerebral venous thrombosis. And for that, if it's a provoked CVT, then I think usually it's three to six months. If it's unprovoked, up to maybe six to 12 months or even longer, depending on the profile. And if there's a persistent provoking factor, such as cancer, antiphospholipid antibody syndrome, then the treatment is lifelong or until this condition subsides. There's a lot of controversy about the duration of treatment. The European guidelines were very helpful in identifying the duration of treatment. Hopefully, also, we have some guidelines or at least a scientific statement by the AHA that also doles details out and provides some guidance to practitioners. Dr. Negar Asdaghi:         Shadi, what should be our top two takeaways from the current meta-analysis and also ACTION-CVT? Dr. Shadi Yaghi:               So, really, the top two from ACTION-CVT and the meta-analysis are, first is direct oral anticoagulants have a comparable efficacy to vitamin K antagonists in terms of recurrent venous thrombosis and achieving venous recanalization on follow-up imaging. And then the second point is direct oral anticoagulants are probably safer than vitamin K antagonists. We have to keep in mind that this data is based mostly on observational studies. And, as we mentioned earlier, we need more randomized controlled trials to support these findings. Dr. Negar Asdaghi:         Dr. Shadi Yaghi, it was a pleasure interviewing you on the podcast. Thank you very much for joining us, and we look forward to having you back on the podcast and reviewing this topic again in the future. Dr. Shadi Yaghi:               Thank you so much. I appreciate you having me. Dr. Negar Asdaghi:         Thank you. And this concludes our podcast for the October 2022 issue of Stroke Please be sure to check out this month's table of contents for the full list of publications, including an important update from the European Stroke Organisation by Prof. Martin Dichgans. I also want to draw your attention to this month's InterSECT paper, which is our International Stroke Early Career and Training section, to discuss the key topic of burnout and mental health amongst physicians, especially amongst neurologists and stroke neurologists. It's alarming to read in this article that neurology is one of the specialties with the highest reported rates of burnout syndrome, and stroke neurologists are at particularly higher risk than other neurological subspecialties. The article tackles some tough subjects, such as the barriers for physicians to seek help and important strategies to mitigate burnout and how to improve mental health in general. I think it's also timely to know that October is the Mental Health Awareness Month, and the theme for October 2022 is "Back to Basics." The basics of recognizing the burden of stress, anxiety, the burden of isolation and depression, not only on those who we take care of, but also on those who give care to us. So, whether you're a stroke physician, a stroke caregiver, or whether you've been touched by this disease in some way or shape, please know that you are part of the stroke community and a part of our Stroke podcast family. Thank you for listening to us, and, as always, stay alert with Stroke Alert. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.  

We have an amazing Grand Rounds follow up interview for you today! Dr. Diogo Haussen, Director of Neuroendovascular Service at the Marcus Stroke & Neuroscience Center at Grady Memorial Hospital joined us for a Grand Rounds presentation with medical students and faculty at McGovern Medical School. His presentation was titled, Carotid Webs: Armed and Dangerous. Our Senior Neurology Resident, and future UT Stroke Fellow, Mohammad Ahmad, interviewed Dr. Haussen following his presentation to ask some more in depth questions. As with our previous Grand Rounds episode, we added the Q&A from the live Grand Rounds because it added so much value to this episode. __________ The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ Host: Mohammad Ahmad, Neurology Resident, UTHealth Houston Guest: Dr. Diogo Haussen | https://www.gradyhealth.org/doctors/diogo-haussen Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gma

A large majority of stroke awareness, stories and advocacy is centered around older or aging populations. When we think about stroke, we envision an adult or a person with high risk factors, adult risk factors, such as smoking, drinking, high blood pressure, etc…. Though more common in adults, stroke is among the top 10 causes of death in pediatric patients. Kyler's family have become advocates for pediatric stroke awareness. Telling and retelling their story through AVM Alliance, a Cure for Kyler and Friends, an organization they started to raise funds for AVM Foundation and the AVM Research Foundation in an effort to better the lives , support networks, and medical care of those affected by aneurysms and other types of vascular malformations of the brain. I spoke with Kyler's mom, Raylene, about a year ago to learn about Kyler's story and her presence, fierceness, and no-quit attitude has stuck with me ever since then. She is not only fighting for her own son, but so many more children , families, and caregivers living with the fallout of pediatric stroke. And she's built quite an amazing community around it all. Learn more about Kyler and his journey, the AVM Alliance, A Cure for Kyler and Friends, visit https://www.facebook.com/AVMAlliance go to cureforkyler.com, avmalliance.com or search the hashtag #ACureForKyler __________ The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ Host: Amy Quinn, Communications Director for the Stroke Institute Guest: Kyler and Raylene Lewis Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

In today's episode, Dr. Seema Aggarwal sat down with Dr. Yejin Kim to discuss Dr. Kim, along with many other UTHealth Houston and Stroke Institute researchers, an article from March 2022, a counterfactual analysis of differential comorbidity risk factors in Alzheimer's disease and related dementias. Their analysis discovered different comorbidities that predispose older African Americans to AD compared to Caucasian counterparts. The findings from their study, which used data collected from nationwide electronic health records will assist in developing a targeted treatment for AD. Their discussion also provided great insight into the processes Kim and her team went through to complete their study and their hopes for applications in the future. __________ The Institute for Stroke and Cerebrovascular Disease (UTHealth Stroke Institute) http://www.utstrokeinstitute.com/ Host: Seema Aggarwal, PhD, APRN, AGNP-C Guest: Yejin Kim, PhD Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Each year we welcome a new class of fellows. This episode is a "wrap up" of their time with us this past year! Hosts: Amy Quinn, James Grotta, MD, Amanda Jagolino-Cole, MD Guests (Fellows): Drs. Stuart Fraser, Ivo Bach, Praveen Hariharan, Pamela Zelnik, Sishir Mannava StrokeBusters, a Podcast Presented by: The Institute for Stroke and Cerebrovascular Disease at the University of Texas Health Science Center at Houston (UTHealth) or “Stroke Institute" About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news in stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many who are experts in their field, to discuss their practice, cutting-edge research and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Contact Web: http://www.utstrokeinstitute.com Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke LinkedIn: @UTHealthStroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

Meet Dr. Christopher M. Putman, a board-certified interventional neuroradiologist with over 20 years of experience. He treats a variety of complex intracranial, head and neck, and spine vascular conditions including acute stroke, cervical and intracranial stenosis, vascular malformations, cerebral aneurysm, and venous occlusive diseases. https://www.pacificneuroscienceinstitute.org/stroke-neurovascular/our-center/

In this episode, NMHA Medical Director Dr. Zach Finn interviews North Memorial's Chair of Stroke Neurology and internationally recognized stroke neurologist Dr. Irfan Altafullah, who has helmed the North Memorial Stroke Program since 1991. Joining Him is Jackie Feyereisen, The Stroke Program Manager at North Memorial Health Hospital in Robbinsdale. Join the crew for an explanation of Strokes like you've never heard before!North Memorial is Minnesota's first DNV-GL accredited Comprehensive Stroke Center and offers a full suite of services including the incredible Stroke rehab program that offers a one-of-a-kind Intensive Aphasia program.Learn more:https://northmemorial.com/condition/stroke-program/https://northmemorial.com/condition/intensive-programs/Ready to take your EMS career NORTH? Join a team committed to unmatched care for every single clinical condition by visiting jobs.northmemorial.comIntro Provided by Mn Native and Voice Actor Brady LaRock

As the no. 3 ranked neurology and neurosurgery program in the country, RUSH University Medical Center is at the forefront of providing leading edge care and participating in pathfinding neuro-interventional research. At the center of this work is R. Webster Crowley, MD, who discusses Rush's use of the CorPath robotic system, Woven EndoBridge Embolization System and the RIST catheter. He is the chief of the Section of Cerebrovascular and Endovascular Neurosurgery, as well as the surgical director of the Comprehensive Stroke Center. He is also the director of the Endovascular Neurosurgery Fellowship and his research interests include stroke, aneurysm treatment, pseudotumor cerebri and subarachnoid hemorrhage. “We were one of the first programs to use the CorPath endovascular robot, which is used to diagnose cerebral angiograms, but has the potential for broader interventional uses with aneurysm and stroke treatment in the future. Rush also performed the first surgery in the world using the RIST catheter, which helps neurosurgeons access cerebral aneurysms with a better safety profile. Our neuro interventional program allows us to expand the ways that patients have access to the latest minimally invasive care.”   CME Credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpenSub#/event/485661 

In this episode, we sat down with Dr. Suja Rajan following her groundbreaking presentation on the cost-effectiveness of mobile stroke units at the 2022 International Stroke Conference in New Orleans. Dr. Rajan and co-researchers aimed to prove “if outcome improvements associated with MSUs justify [an] increase in costs, thereby making MSUs cost effective, or if the outcome improvements lead to follow-up cost reductions thereby making MSUs cost-saving.” https://www.hmpgloballearningnetwork.com/site/neuro/conference-coverage/mobile-stroke-unit-utilization-cost-effective This was the first study that provided an economic evaluation using 1-year follow-up data on the cost-effectiveness of MSUs. Dr. Suja S. Rajan is a Health Economist and Econometrician, and is currently an Associate Professor at the School of Public Health, UT Health in Houston. Dr. Rajan's research interests include women's health, stroke and cancer health outcomes research, determining the effect of socio-economic determinants of health, identification and resolution of racial-ethnic, socio-economic and gender disparities, evaluating programs that address these disparities, and conducting cost-effectiveness and cost-benefit evaluations to establish the business case for medical interventions. Twitter: @UTHealthStroke Instagram: @UTHealthStroke Facebook: facebook.com/uthealthstroke Ideas and opinions are our own and this podcast is not a substitute for expert medical advice. About StrokeBusters is a podcast series of recorded conversations on the topic of stroke and cerebrovascular disease. Based in the Texas Medical Center, the largest medical center in the world, we tap into our local network of astonishing leaders in healthcare and medicine to discuss the latest and most exciting news on stroke. Throughout this ten-episode series, we connect with UTHealth physicians and researchers, many of who are experts in their field, to discuss their practice, cutting-edge research, and medical care. Who We Are The Institute for Stroke and Cerebrovascular Disease, better known as the Stroke Institute, serves as a multi-disciplinary hub for research and best practices in stroke recovery, stroke prevention, services, population health, and vascular dementia. We are one of the most active research and clinical programs in the country, the first Comprehensive Stroke Center in the state, and launched the first Mobile Stroke Unit in the nation. Our stroke program, founded by Dr. James Grotta in 1979, specializes in stroke epidemiology, clinical trial design, and basic science. We train the next generation of revolutionary academics and leaders in cerebrovascular disease through our NINDS-funded fellowship programs. Contact For more information or if you have any questions, please contact us at info.uthiscd@gmail.com

Dr. David Fiorella, https://www.stonybrookmedicine.edu/ (Stony Brook University Hospital) The director of the Stony Brook Cerebrovascular Center and co-director of the Stony Brook Cerebrovascular and Comprehensive Stroke Center at Stony Brook University Hospital comes on-air with Gianna Volpe in support of WLIW-FM during the Chairman's Challenge. All donations made to https://www.wliw.org/radio/ (WLIWFM.org) today through the end of March are triple-matched dollar-for-dollar up to $50,000. Dr. Fiorella discusses brain aneurysms, their effect on the population, plus how one clinical trial has been saving lives on L.I. and transforming the treatment of patients with aneurysms. Melanie McEvoy, The Monday Meditation Underwritten by http://www.cynthiadaniels.net/ (Monk Music Studios) North Fork Breast Health Coalition leader Melanie McEvoy Zuhoski comes on-air with Gianna Volpe in support of WLIW-FM during the Chairman's Challenge. McEvoy discusses the return of the coalition's annual https://www.northforkbreasthealth.org/events (Pink Pearl Gala) – now in its sixth year – taking place April 8 at the East Wind. The gala will posthumously honor Keri Stromski with the inaugural medal of valor, as well as the Peconic Sportsman Club with the community spirit award for years of raising funds for NFBHC and other breast cancer awareness organizations. The event will have many ways to give and receive, all while socially distant.

Season 2 Episode 7 -Lester Y. Leung, MD, MSc Tufts MCQuick Bio:Board certified vascular & general neurologistAssistant Professor of NeurologyDirector, Comprehensive Stroke Center at Tufts Medical CenterDirector and Founder, Stroke and Young Adults (SAYA) ProgramPrincipal Investigator, Tufts Vascular Neurology Research GroupDirector, Stroke Service at MetroWest Medical CenterCo-Chair, American Heart Association-American Stroke Association Massachusetts Stroke Systems of CareThis was a real impactful episode for my co-host Mike and I as we convened late this past Sunday evening to interview board certified vascular and general neurologist, Lester Leung, MD, MSc of Tufts MC.   For myself (co-host David Dansereau), this episode was also very personal as I was able to thank Lester for the critical role he played in my own stroke recovery both as my neurologist and as a friend and coach.  Lester grew up in New Orleans,  LA and after coming to Boston to attend college he returned home to New Orleans for medical school and found himself on a mission to help rebuild New Orleans post Hurricane Katrina. From this early advocacy, rebuilding homes and riding with EMS to help Katrina victims “where they were” he was moved and impacted by the fractured healthcare system and all the challenges it presented for victims during an emergency like Katrina.  Lester credits these early lessons learned as well as having really dynamic mentors along the way, in particular New Orleans based stroke neurologist Sheryl Martin-Schild, MD,PhD for enlightening him on how people with stroke are suffering and have multifaceted unmet needs.  This early career experience solidified Dr. Leung's dedication to neurology and when he later moved back to Boston to begin his career you'll learn how these early lessons sparked his passion to do more for the stroke community, with a special interest in the needs of young stroke. This was a moving and enlightening discussion and together, Lester, Mike and I unpacked many stroke topics including: Exploring and studying screening of late complications after stroke among stroke survivors, esp. young stroke survivorsDr Leung's advocacy to spearhead a statewide/regional/(global)* PSA on the need to seek emergency care for stroke despite the pandemic surge. * Mike revealed he even viewed and heard Lester's PSA used across the Atlantic as a model to use as a stroke awareness call to action while in Dublin!Treating patients at Tufts in later time windows after stroke (late presenter thrombolysis)Understanding disparities and stroke recovery outcome, including novel factors like neighborhood income inequality, and community investment in stroke rehab resources.  Use of high technology and investment in stroke recovery vs high touch longitudinal coaching and education models and how both involve following the reimbursement dollars for care delivery and addressing recovery plateausThe Comprehensive Stroke Center at Tufts, including its first in the nation SAYA Program (Stroke And Young Adult)  an outpatient longitudinal care model founded by Dr. Leung.  Watch on YouTube: https://youtu.be/YEp0i78HtyIhttp://lesterleung.comhttp://youngadultstroke.orghttps://www.tuftsmedicalcenter.org/physiciandirectory/lester-leungPSA from Tufts : https://youtu.be/UdHSYjKzG-gFor more information about joining our show or advertising with us visit: https://enable4us.comSupport the show (https://paypal.me/SmartMovesPT)

Welcome to the Follow The Brand Podcast!  I am your host Grant McGaugh CEO of 5 STAR BDM. The focus of this episode is centered on Leverage and Opportunity.  Our next guest has taken the unique skills he has acquired over 20 years of running the day-to-day operations of hospitals to the C-Suite at Atrium Health.  He is committed to improving the status of healthcare across this country and is in the business to make a difference in his community.He uses his skillsets in business acumen, operational efficiency, and leadership development to empower and engage his workforce with innovative platforms that impact his community.   Learn the importance of having a vision that reflects on your WHY and builds powerful relationships.   BIORoy Hawkins, Jr., FACHE, currently serves as the President of Atrium Health North Market encompassing Atrium Health Cabarrus, Atrium Health Stanly, Atrium Health University City  and the free-standing emergency departments in Huntersville, Harrisburg, and Kannapolis.  Roy's focus is on achieving strategy execution for the market in alignment with Atrium  Health's overall goal of operational excellence in key facilities.  Roy has served in leadership roles in academic, for-profit, not-for-profit, and government healthcare systems. Before joining Atrium Health, Roy served as Senior Vice President and  Chief Executive Officer of Jackson Memorial Hospital in Miami, FL, with strategic and  operational oversight for one of the nation's largest hospitals. He has overseen multiple  business units and premier service lines, including the emergency care center, the critical care division, Ryder Trauma Center, and the Miami Transplant Institute – the largest transplant center in the United States and the only center in Florida that performs every type of transplant.  Before joining Jackson Memorial, Roy was Senior Vice President and CEO of Jackson North  Medical Center, a 382-bed Jackson Health System-affiliated acute care hospital located in  North Miami Beach. Roy joined Jackson Health System after serving as the Chief Operating  Officer of Johnston-Willis Hospital, a 292-bed HCA affiliated facility in Richmond, VA. In that role, he led the organization through a record-breaking year inpatient volumes and  spearheaded the hospital's efforts to achieving Comprehensive Stroke Center certification.  Additionally, he had executive oversight for the hospital's Emergency Department, Surgical  Services, Sarah Cannon Cancer Institute, and their rehabilitation unit. Roy also has experience in various Veteran Affairs healthcare organizations, including serving  as interim CEO, COO, and deputy medical center director at James A. Haley Veterans'  Hospital in Tampa, FL, as well as holding numerous executive positions at VA Sunshine  Healthcare Network in St. Petersburg, FL, Orlando VA Medical Center, VA Southeast Network  in Duluth, GA, and the Miami VA Healthcare System. Roy holds a Bachelor of Business Administration degree from Howard University in  Washington D.C., and a Master of Health Administration degree from Florida International  University in Miami.

The RUSH System for Health excels in stroke prevention and care. RUSH University Medical Center is certified as a Comprehensive Stroke Center by the Joint Commission and RUSH has two certified Primary Stroke Centers in Oak Park and Aurora/Fox Valley. Given the time-sensitive nature of stroke care, RUSH seeks to expand current treatment windows and improve technologies used to treat emergency strokes as quickly and effectively as possible to minimize damage to our patients. Michael Chen, MD, a professor of neurology, neurosurgery and radiology at RUSH University Medical Center, discusses the ways RUSH is efficiently diagnosing stroke, how it is differentiating actual cases of large vessel occlusion stroke with false positives and how RUSH handles the benefits and challenges of using thrombectomy. Dr. Chen has authored over 100 peer-reviewed scientific publications and also serves as a senior editor for the Journal of Neurointerventional Surgery. Dr. Chen currently serves as President-Elect for the Society of Neurointerventional Surgery. “There's strong evidence that highly effective therapies exist for stroke and they're also very time sensitive. If you have a large vessel occlusion stroke, 75% of the time patients are not going to do well. Thrombectomy can reduce that chance of a horrible outcome by half. The question is not necessarily whether you can make the diagnosis and what you do, but what work you have done ahead of time to prepare for the event when that patient does come into your emergency room.” CME credit link: https://cmetracker.net/RUSH/Publisher?page=pubOpen#/EventID/483128

A National survey says only 40% of U.S. adults who have witnessed a stroke called 911 as their first reaction.  In fact, stroke symptoms come on suddenly and require immediate emergency care, but only 1 in 5 respondents could recognize 10 signs and symptoms of a stroke. Dr. Sheryl Martin-Schild:Dr. Martin-Schild graduated from the Tulane University School of Medicine, while also obtaining her PhD in Neuroscience.  Dr. Martin-Schild completed a combined internal medicine and neurology residency at Tulane University School of Medicine, followed by fellowship training in Vascular Neurology and clinical research in Vascular Neurology at the University of Texas Health Science Center in Houston, Texas.Dr. Martin-Schild founded and directed the Stroke Program at Tulane Medical Center 2008-2016. She advanced Tulane Medical Center to Primary Stroke Center level in less than 2 years from inception and Comprehensive Stroke Center 3 years later. Her service delivered the highest rate of and most efficient with thrombolytic treatment for ischemic stroke in Louisiana.  Dr. Martin-Schild serves as the Statewide Stroke Medical Director for the Louisiana Emergency Response Network. She is the President & CEO of Dr. Brain, Inc., which provides on-site stroke leadership and patient care to hospitals committed to improving or developing stroke programs. She currently serves as the Medical Director of Neurology & Stroke for the New Orleans East Hospital and Touro Infirmary. Dr. Martin-Schild's research focuses on access to stroke care, racial disparities in the outcome, and augmentation of rehab potential with neurostimulators. She has more than 100 manuscripts published in peer-reviewed journals.   For more information about the signs, symptoms, and risk factors for stroke, visit www.strokeawareness.com 

A National survey says only 40% of U.S. adults who have witnessed a stroke called 911 as their first reaction.  In fact, stroke symptoms come on suddenly and require immediate emergency care, but only 1 in 5 respondents could recognize 10 signs and symptoms of a stroke. Dr. Sheryl Martin-Schild:Dr. Martin-Schild graduated from the Tulane University School of Medicine, while also obtaining her PhD in Neuroscience.  Dr. Martin-Schild completed a combined internal medicine and neurology residency at Tulane University School of Medicine, followed by fellowship training in Vascular Neurology and clinical research in Vascular Neurology at the University of Texas Health Science Center in Houston, Texas.Dr. Martin-Schild founded and directed the Stroke Program at Tulane Medical Center 2008-2016. She advanced Tulane Medical Center to Primary Stroke Center level in less than 2 years from inception and Comprehensive Stroke Center 3 years later. Her service delivered the highest rate of and most efficient with thrombolytic treatment for ischemic stroke in Louisiana.  Dr. Martin-Schild serves as the Statewide Stroke Medical Director for the Louisiana Emergency Response Network. She is the President & CEO of Dr. Brain, Inc., which provides on-site stroke leadership and patient care to hospitals committed to improving or developing stroke programs. She currently serves as the Medical Director of Neurology & Stroke for the New Orleans East Hospital and Touro Infirmary. Dr. Martin-Schild's research focuses on access to stroke care, racial disparities in the outcome, and augmentation of rehab potential with neurostimulators. She has more than 100 manuscripts published in peer-reviewed journals.   For more information about the signs, symptoms, and risk factors for stroke, visit www.strokeawareness.com 

Episode 6 features Dr. Anmar Razak, Medical Director of the Sparrow Stroke Center, discussing the signs and symptoms of Stroke as well as the only Comprehensive Stroke Center in Mid-Michigan.

Nationwide, thousands of people are experiencing strokes following a COVID-19 infection –especially younger people who don’t typically experience strokes. The experts in the Comprehensive Stroke Center at MemorialCare Long Beach Medical Center have learned to care for these patients and help reduce the inflammation of the brain and other “long-hauler” symptoms caused by COVID-19.

Saint Luke's Hospital of Kansas City Trauma & Critical Care Specialists As a designated Level I Trauma, Stroke, and STEMI Center by the Missouri Department of Health & Senior Services, Saint Luke's provides total care for every aspect of injury—from prevention through rehabilitation. In addition, Saint Luke's Hospital is designated by The Joint Commission as a Comprehensive Cardiac Center and Comprehensive Stroke Center. Saint Luke's Hospital has also achieved four consecutive Magnet® designations for outstanding patient outcomes and satisfaction, a feat achieved by less than two percent of all hospitals worldwide. Our expert trauma team involves specialists from a variety of disciplines working seamlessly together to deliver exceptional care: Trauma surgeons, Emergency department physicians, Plastic surgeons, Anesthesiologists, Radiologists, Emergency nurses and technicians, Respiratory therapists, Operating room personnel, Chaplain for family and patient support, Rehabilitation physicians Saint Luke's Hospital trauma staff has the technology and expertise necessary to treat any injury. Community Education programs: Stop the Bleed Death from bleeding can occur in minutes, but so can saving a life. Stop the Bleed is a 90-minute class that teaches participants to carry out a few simple life-saving techniques that make up the basics of emergency, on-the-spot care, including: Direct pressure Wound packing Tourniquet use An initiative from the American College of Surgeons, Stop the Bleed strives to create a national policy to improve survival rates after intentional mass-casualty events. To schedule a class for your group or organization call, 816-932-2246 or email jgiacone@saintlukeskc.org. Saint Luke's Hospital of Kansas City is one of the largest faith-based care hospitals in the region—offering many specialized programs and services. Our network of more than 600 physicians represents more than 60 medical specialties. Saint Luke's Hospital has been recognized by U.S. News & World Report as one of the elite hospitals in the nation. It is nationally ranked in one specialty for 2020-21 and honored as high performing in four additional specialties. Saint Luke's Hospital is a primary teaching hospital for the University of Missouri–Kansas City School of Medicine, which includes a physician residency program.

In this episode, we introduce our listeners to three key role players at Beaumont Hospital - Royal Oak, located in Oakland County Michigan. Beaumont Hospital Royal Oak is a Comprehensive Stroke Center that served 1,319 patients in 2019. Needless to say, that’s a lot. In addition, Beaumont Royal Oak is a participating hospital in the OCMCA Stroke Study. In this discussion, we’re joined by Dr. Rebbeca Grysiewicz, Comprehensive Stroke Program Medical Director, as well as Beaumont Royal Oak’s stroke coordinators Caitlin Woodruff and Wendy Carriveau. They’re here to talk about the value of EMS when it comes to the recognition and treatment of stroke patients. It turns out, EMS has WAYYY more of an impact on the decision-making process a stroke team uses to select a treatment plan for stroke patients. In this episode, our guests will provide us with their perspective regarding the value of EMS and how we can make even more of a positive impact. The OCMCA Stroke Systems of Care Special Study is rapidly expanding. If you’d like to know more information about the OCMCA’s stroke study, or if your agency or hospital would like to participate, visit OCMCA.org/stroke. There you’ll find all the information you need about the study and how your EMS agency or hospital can participate. You’ll even find study data, as well as a few presentations that you can download. You don’t have to be located in Michigan to participate. The OCMCA would LOVE participants from all over the US help us to identify the strengths and weaknesses of implementing a stroke severity scale, so that we can share the knowledge amongst the entire prehospital community. Visit EMSonAIR.com for the latest information, podcast episodes and other details. Follow us on Instagram @EMSOnAIR.Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR Podcast team by email at QI@OCMCA.org.

: Dr. Martin-Schild graduated from the Tulane University School of Medicine, while also obtaining her PhD in Neuroscience. Dr. Martin-Schild completed a combined internal medicine and neurology residency at Tulane University School of Medicine, followed by fellowship training in Vascular Neurology and clinical research in Vascular Neurology at the University of Texas Health Science Center in Houston, Texas. Dr. Martin-Schild founded and directed the Stroke Program at Tulane Medical Center 2008-2016. She advanced Tulane Medical Center to Primary Stroke Center level in less than 2 years from inception and Comprehensive Stroke Center 3 years later. Her service delivered the highest rate of and most efficient with thrombolytic treatment for ischemic stroke in Louisiana. Dr. Martin-Schild serves as the Statewide Stroke Medical Director for the Louisiana Emergency Response Network. She is the President & CEO of Dr. Brain, Inc., which provides on-site stroke leadership and patient care to hospitals committed to improving or developing stroke programs. She currently serves as the Medical Director of Neurology & Stroke for the New Orleans East Hospital and Touro Infirmary. Dr. Martin-Schild’s research focuses on access to stroke care, racial disparities in outcome, and augmentation of rehab potential with neurostimulants. She has more than 100 manuscripts published in peer-reviewed journals. On behalf of Genentech, a nationwide Stroke Awareness Survey was conducted on March 25 – April 10, 2020 among 2,009 adults ages 35+ in the U.S. BE FAST was developed by Intermountain Healthcare, as an adaptation of the FAST model implemented by the American Stroke Association. Reproduced with permission from Intermountain Healthcare. © 2011 Intermountain Healthcare. All rights reserved. Support for this campaign is provided by Genentech Inc., a member of the Roche Group. © 2020 Genentech USA, Inc. All rights reserved

I join Frank Stickler in this episode to talk all things nursing since his departure from Hershey, PA to colorful Colorado! We dive into his experiences working while attending school, what working night shift was like, some unique things about working at a Primary Stroke Center as opposed to a Comprehensive Stroke Center and some interesting times treating patients with toxicities! Moving along, is his current role in a Neuroscience Critical Care Unit, what is was like to have and survive Covid-19 and what is next for Frank! Frank started as a CNA in 2008 at Good Samaritan Hospital in Lebanon, PA while in high school. He worked full-time night shift as CNA at HMC while going to nursing school. Frank was apart of the last graduating class of Lancaster General College of Nursing and Health Sciences (now Pennsylvania College of Health Sciences) and received his ASN in 2013. He is only 4 weeks away from achieving his BSN from the University of Texas. Frank has worked in Neuroscience for several years with experience in Neuro/Stroke/Tox/Medicine and Neurocritical Care. He is currently a Neuroscience Critical Care RN at the University of Colorado Hospital where he serves as a charge nurse, preceptor, recourse RN, educator and nerd for anything neuro. Frank is also a personal colleague of mine who has survived COVID-19. He currently lives in Centennial, Colorado with his partner, Mike, dog and 2 cats.

In conversation with Dr. Jignesh Shah - Director for Comprehensive Stroke Center, & Director for Tele-Neurology Services at Baptist Lexington Hospital in Kentucky Access to healthcare services is a serious issue, especially in rural America. Citizens of the USA should be able to conveniently and confidently access services such as primary care, dental care, behavioral health, emergency care, and public health services. Access to health care is vital for the prevention of disease, detection and treatment of illnesses, quality of life, preventable death and improving life expectancy. For rural residents to have sufficient healthcare access, necessary and appropriate services must be available and obtainable on time. Even when an adequate supply of health care services exists in the community, there are other factors to consider regarding healthcare access. For instance, to have good health care access, there has to be access to providers. For more information, please visit: https://paha.us/

Karen is almost famous. She is a wife, a mother, a sister, a daughter - and a stroke survivor. Orlando Health had the pleasure of recounting her treatment and care through the Comprehensive Stroke Center, located at Orlando Regional Medical Center.Click here to listen to her story.Here she is behind the scenes.===== Visit unclemarv.com to listen to other great showsSee live shows on YouTube and  The FacebookHost: Marvin Bee (marvin@unclemarv.com)Twitter: @iamunclemarvRSS: https://feeds.simplecast.com/dbgzAfi5 

Host: Interim President Michael Bernstein About Dr. Fiorella: Dr. David J. Fiorella, Director of the Stony Brook Cerebrovascular Center, Co-Director of the Stony Brook Cerebrovascular and Comprehensive Stroke Center, and Professor of Neurosurgery and Radiology joined the Department of Neurosurgery in 2009. Dr. Fiorella is considered a pioneer in the field of neuro-interventional therapies, advancing new devices and techniques for the treatment of Cerebrovascular disease. Dr. Fiorella spearheaded the acquisition of 2 Mobile Stroke units for Stony Brook University Hospital, the first program in Suffolk County. He is the Principle Investigator or Co-PI on numerous national trials evaluating new devices and techniques for the treatment of aneurysms, acute stroke and intracerebral hemorrhage. He is a senior member of the Society for Neuro-interventional Surgery (SNIS) and senior associate editor of the Journal of Neurointerventional Surgery. Dr. Fiorella has been named amongst the best interventional radiologists/endovascular surgeons in Castle Connolly's Top Doctors for several years in a row. About the Episode: Stony Brook Medicine Mobile Stroke Unit founder, Dr. David Fiorella, is considered a pioneer in the field of neuro-interventional therapies -- advancing new devices and techniques for the treatment of Cerebrovascular disease. He took that pioneering inspiration one step further in 2019 when he and a team of Stony Brook clinicians and colleagues launched the first two Mobile Stroke Units on Long Island. These Mobile Stroke Units enable stroke patients to be triaged and treated in the field, wherever the patient is located. Clinicians can administer IV TPa, a medication that minimizes brain injury, at any remote location and then immediately transport the patient to the closest appropriate care facility, where physicians can initiate further care. In this episode of “Beyond the Expected,” Michael Bernstein talks to Dr. Fiorella about his trajectory as a vascular brain surgeon and what inspired him to pursue the complex initiative of starting a Mobile Stroke Unit program. You'll also hear heartwarming stories of patient survival, and learn what this groundbreaking program has meant for Long Island stroke care since it launched in April 2019. Credits: Thanks to Dr. David Fiorella Guest Host: Michael Bernstein Executive Producer: Nicholas Scibetta Producer: Lauren Sheprow Art Director: Karen Leibowitz Assistant Producer: Emily Cappiello Assistant Producer: Joan Behan-Duncan Social Media: Meryl Altuch, Casey Borchick Podcast photography and YouTube Technician: Dennis Murray Podcast Director: Jan Diskin-Zimmerman Engineer/Technical Director: Phil Altiere Production Manager: Tony Fabrizio Camera/Lighting Director: Jim Oderwald Camera: Brian DiLeo Camera: Greg Klose Original score: “Mutti Bug” provided by Professor Tom Manuel Special thanks to the Stony Brook University School of Journalism for use of its podcast studio.

First and foremost, we would like to thank all pre-hospital providers for the work you do. You are all underpaid, understaffed, and under appreciated. However, the unsung work that you do matters now more than ever. We go to work every day in order to be there when the public needs us. Much of the focus as of late has been on COVID. And probably rightfully so. But patients continue to have MI’s, strokes, overdoses and many other emergencies. And these emergencies still deserve our excellent care and diligence not to miss. So although we plan to have another special-edition, COVID-update episode we don’t want to neglect these other emergencies. So let's talk about Large Vessel Occlusions. Ep. 2 Large Vessel Occlusion (LVO) Show Notes First and foremost we would like to thank all prehospital providers for the work you do. You are all underpaid, understaffed, and under appreciated. However, the unsung work you do now more than ever matters. We go to work every day in order to be there when the public needs us. Much of the focus as of late has been on COVID. And probably rightfully so. But that being said, patients continue to have MI’s, strokes, overdoses and many other emergencies. And these emergencies too still deserve our excellent care and diligence not to miss. So although we plan to have another special edition COVID update episode soon we don’t want to neglect these other emergencies. This month we talk Large Vessel Occlusions. Endovascular Stroke therapy (EST) for large vessel occlusion (LVO) - This is the hottest therapy since PCI - 12 studies since 2013, 5 studies in 2015 alone https://rebelem.com/endovascular-therapy-for-acute-ischemic-stroke-the-new-shiny-toy-in-stroke-care/For a nice review of all of the studies and evolution of endovascular therapy visit: How is EST performed? A catheter is guided through one of the femoral arteries and up through the carotid and into the distal internal carotid, anterior cerebral artery or the middle cerebral arteryA clot retrieval device is fed through the catheter in order to retrieve the clotUnlike tPA which has only shown very marginal benefit in just a few studies that were admittedly methodologically flawed. EST has recently had multiple strongly positive trials showing impressive benefits (although these benefits are likely over estimated, see the link above for a deep dive on the researches strengths and weaknesses) Who Qualifies for EST?Similar to the early days of PCI for myocardial infarctions when cath lab centers were farer and fewer betweenWill likely vary based on your stroke center and may change with future studies so make sure you stay up to date with your local protocols.Initial studies looked at less than 6 hour time window and is what the American stroke guidelines currently recommend. A lot of places have started pushing this time window further out and locally here we us a cut off of less than 24 hoursInitially studies for all comers with stroke receiving EST found no benefitIt wasn’t until they identified a subset of patients with Large Vessel Occlusions (LVO) that they began to see these impressive benefitsAn LVO is defined as clot located in either the distal internal carotid, proximal anterior cerebral artery (ACA), or the proximal middle cerebral artery (MCA)Not every stroke center has the capability to perform ESTWhat is the timeline to qualify for ESTSo do we need to start re-organizing our transport priorities and transporting all of our suspected strokes to EST centers similarly to how we transport all of our STEMI’s to cath centers?With STEMI we have a clear diagnostic tool with our EKG to determine if somebody needs the cath lab. In order to know for sure if our patient would need EST we would need a CT scanner. And not just CT but also the ability to do CT with contrast in order to see which vessel the clot is in.If there is even a clot at all. Given so many mimickers of stroke on a very small percentage of patients evaluated for concern for stroke actually end up having a strokeWhich brings us to the second point of why we don’t want to start transporting to only EST centers: Only a select number of stroke patients, those with clots in the large proximal vessels, will benefit from this therapy. It wasn’t until later trials when they narrowed the patients they were treating to those with identified LVO in the arteries mentioned before: distal internal carotid, proximal ACA, and proximal MCA that they started finding benefit. It turns out that only 1 in 770 of stroke patients will have an occlusion meeting criteria for EST. And that's in patients who WE KNOW are having a stroke. Can you imagine what that number would be if we included everyone we just suspected of having a stroke? We would overwhelm the hospital. Early trials from 2013 looked at utilizing this therapy for all comers with stroke and found no benefit when compared to tPA alone. So even if we were sure our patient was having a stroke based on our exam they still would only benefit from transport to an EST if it was in one of these specific large and proximal vessels.No, here’s where we don’t wanna get ahead of ourselves So are there any physical exam findings to help us determine those likely to have a LVO and thus should be transported to one of these centers?There’s not strong enough evidence to suggest such a protocol yet so for now keep transporting to your nearest local stroke center per your protocol But there are researchers looking at some prehospital scores to help with this question and we should be aware of and keep on the lookout for future data and research on this. See some of the prehospital scores and their associated ealy research below.VAN score - vision, aphasia, neglect62 patients, 31% (19) were VAN positive90% of those had an LVO and no LVO’s occured in the VAN neg group. This is a small feasibility study. This means it was a smaller study done solely to determine if a larger more robust trial should be completed. Feasibility trials should not be used to change current care.Start with bilateral arm raise for 10 seconds if any drift then proceed with the VAN assessment, If any of the following are positive in a patient with arm drift then they are considered VAN positiveCheck all 4 quadrants one eye at a timeI cover one eye and ask 1 or 2 fingers in each quadrant. If the patient is having difficulty cooperating you can blink to threat in all quadrants. Move your hand quickly towards their eye from the quadrant you are testing (but don’t actually hit them).If they blink you assume the vision is intact.Blink to threatAphasia either expressive or receptive. Can’t say words or doesn’t say the right words Unable to understand what you are saying. ExpressiveReceptiveImportant: Aphasia is different from dysarthria which is slurred speech.Dysarthria is not what we are testing or scoring here.Have the patient close both eyes and then you touch both of their arms with your fingers and ask which arm you are touching, if the patient fails to identify the weak arm (the arm you identified with a drift earlier) this is considered neglect. Other signs of neglect are an inability to track your finger beyond midline or a forced gaze deviation to one side. Visual fieldsThe next component is AphasiaFinally NeglectAbout the data: https://jnis.bmj.com/content/neurintsurg/9/2/122.full.pdfHow do you do the exam? Cincinnati pre-hospital severity stroke scaleIn the original derivation study it was found to have a sensitivity 83% and specificity 40% for identifying patients with a LVO. Katz BS, Mcmullan JT, Sucharew H, Adeoye O, Broderick JP. Design and validation of a prehospital scale to predict stroke severity: Cincinnati Prehospital Stroke Severity Scale. Stroke. 2015;46(6):1508-12.Kummer BR, Gialdini G, Sevush JL, Kamel H, Patsalides A, Navi BB. External Validation of the Cincinnati Prehospital Stroke Severity Scale. J Stroke Cerebrovasc Dis. 2016;25(5):1270-4.However, in an externally it was found to have a sensitivity of 70% and specificity of 86%. About the data:See MDcalc for the scoring details: https://www.mdcalc.com/cincinnati-prehospital-stroke-severity-scale-cp-sss#next-stepsRACEIn the original study a RACE Scale value of ≥5 had a sensitivity 85% and a specificity of 68% for identifying an LVO. Pérez de la Ossa N, Carrera D, Gorchs M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke. 2014;45(1):87-91.A second study was designed to assess whether or not bypassing patients to a Comprehensive Stroke Center with a RACE Scale ≥5 would improve outcomes. Zaidi SF, Shawver J, Espinosa morales A, et al. Stroke care: initial data from a county-based bypass protocol for patients with acute stroke. J Neurointerv Surg. 2016; Jun 24. pii: neurintsurg-2016-012476. doi: 10.1136/neurintsurg-2016-012476. [Epub ahead of print]The results of this study showed an increased treatment rate, improved door-to-CT times, and improved door-to-needle times. The rate of mechanical thrombectomy also increased with improved arrival-to-puncture and arrival-to-recanalization times as well. However, there was only a small trend toward improved outcomes that did not reach statistical significance.About the data:See MDcalc for the scoring details: https://www.mdcalc.com/rapid-arterial-occlusion-evaluation-race-scale-strokeFAST EDLima FO, Silva GS, Furie KL, et al. Field Assessment Stroke Triage for Emergency Destination: A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes. Stroke. 2016;47(8):1997–2002. doi:10.1161/STROKEAHA.116.013301 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4961538/https://www.ahajournals.org/doi/full/10.1161/strokeaha.116.016026The data:There’s an app for thatELVO screen Kentaro Suzuki , Nobuhito Nakajima, Kenta Kunimoto, et. al. Emergent Large Vessel Occlusion Screen Is an Ideal Prehospital Scale to Avoid Missing Endovascular Therapy in Acute Stroke.. Stroke. 2018;49:2096–2101.The data:American stroke algorithm for when to bypass and transport to an EST capable facilityAlgorithm: https://www.heart.org/-/media/files/professional/quality-improvement/mission-lifeline/2_25_2020/ds15698-qi-ems-algorithm_update-2142020.pdf?la=en&hash=A0AB5E209AC78933C54E41C3FF235B60F9CC4A7CComplete reference:https://www.heart.org/en/professional/quality-improvement/mission-lifeline/mission-lifeline-strokeJoin Triage Apphttps://apps.apple.com/us/app/jointriage/id1099779970https://play.google.com/store/apps/details?id=net.allm.fasted&hl=en_USApple:Google Play:

If you think you or a loved one may be having a stroke, call 911 IMMEDIATELY and ask them to take you to the nearest Comprehensive Stroke Center. Offering services beyond the scope of primary stroke centers, only Comprehensive Stroke Centers can offer the wider range of specialists and more advanced treatment options needed when standard therapies are not enough. Learn more in this video produced by Sarasota Memorial Hospital's Comprehensive Stroke Center team or visit smh.com/stroke for more information.

Many people associate high blood pressure with heart disease. However, it’s also a major risk factor for strokes that are caused by blood clots. Dr. Richard T. Benson discusses how to lower blood pressure and the most advanced treatment for clot-related strokes.   TRANSCRIPT Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine. Host: Thanks for joining us today. We’re talking with Dr. Richard T. Benson, Associate Medical Director of the Comprehensive Stroke Center at MedStar Washington Hospital Center. Welcome, Dr. Benson. Dr. Richard T. Benson: Thank you. Thank you for having me. Host: Today we’re discussing how hypertension is related to stroke. So many people don’t think of hypertension or high blood pressure as a neurological risk factor. Just the heart or the kidneys typically are what people think could be affected. Could you explain to us why it’s so important to control your blood pressure from the standpoint of a stroke? Dr. Benson: The blood pressure is controlled or it’s a factor of the pressure within your vascular system when the heart is contracting or relaxing. I like to think of a closed system with a pump. So, the heart is the pump and so when that heart contracts, it’s going to create the maximum pressure within that system. When it relaxes, that pressure within the system will decrease. And it’s a closed system in that it’s a loop. You have various organs that are attached that receive the blood from the heart. And then it goes back to the lungs and then back to the heart, so that closes out the loop. And so, just like that pressure impacts the heart, or that high blood pressure when it’s elevated is going to cause extra strain on the heart and the kidneys, it will also cause extra strain on the heart...on the brain. The brain is actually more sensitive because the brain has what’s called an autoregulatory function. The brain tissue is very sensitive to changes in pressure so the arteries in the brain actually have a function where they constrict in order to maintain a constant perfusion pressure to the brain. And so, the brain is very sensitive to changes in blood pressure and so in people with really high blood pressure or labile blood pressures, that can cause great risk to the brain. And so, one of the ways that high blood pressure impacts the brain, or it can cause stroke… There are two major types of stroke - there’s ischemic stroke, which is decreased blood flow to the brain due to blockage of an artery - and that’s about 87 percent of all strokes. The other is a hemorrhagic stroke, which is when there’s bleeding into the brain and one of the major factors in leading to bleeding to the brain is an elevated blood pressure and sort of bursting of an artery in the brain, and that’s about 13 percent of all strokes. And so, in addition to the hemorrhage caused by the high blood pressure, that constant pressure and that constriction of the arterial bed can lead to what we call atherosclerosis, or you start to build up narrowing of the arteries in the brain or changes to the walls of the lining of the arteries due to that chronic hypertension so that chronic elevated blood pressure, and so that leads to damage and narrowing of the arteries in the brain as well which can lead to ischemic strokes and blockage of those arteries. So, hypertension, just like it’s a major risk factor for cardiovascular disease as well as vascular disease affecting the kidneys, it also can cause cerebral vascular disease or disease of the arteries in the brain, as well. So, it’s very important. Because hypertension is so prevalent, meaning that there are a lot of people in society with high blood pressure, and with the new hypertension guidelines among adults so that’s almost one in every two adults in this country that has hypertension, is going to be strongly related and a lot of people at risk for stroke because of that elevated blood pressure. Host: So, along those same lines, for a variety of reasons, younger and younger people are developing high blood pressure in their 30s, 40s, 50s. What do you feel or what would you recommend to stop that problem in young people before it gets out of control? Dr. Benson: One of the major reasons for this epidemic of hypertension is because of obesity. We have an obesity epidemic in this country. Unfortunately, we’re seeing even young kids in grade school that are overweight. And an overweight child becomes an overweight adult. And so, we really have to change that trend of getting young people to exercise, to eat well, to get a proper diet, and to become physically active. And so, unfortunately, I think that we’re seeing more and more younger people, or younger ages of people, with hypertension as a major factor for that is because of obesity. And so, if we can get people active, then I think we can combat that some. Now, the other factor is that there are a lot of people who are very salt sensitive. And so, the American Heart Association also had standards, in terms of the amount of sodium that a person should have in his or her diet daily in order to decrease the sodium intake. So that’s something else to think about. Unfortunately, as societies become more and more active, people tend to have on-the-run meals. They tend to go to fast-food places or whatever’s available. And most of those foods are going to be high in sodium and not as nutritious, and so that also sets us up in this busy society of people sort of eating high sodium foods and leading to obesity, as well as high sodium intake. Host: So, hypertension is often called the silent killer because it typically causes no noticeable symptoms until a tragedy happens. Could you explain how hypertension can physically cause a stroke without a patient noticing within their own body? Dr. Benson: Right. So, the chronic, increased blood pressure in that closed system, it leads to pressure and damage to that inner lining of the walls of the blood vessels in the brain. And that leads to this atherosclerotic disease that can cause narrowing of those arteries. And that’s called a stenosis, a narrowing of an artery in the brain. And then when that artery narrows, it can occlude. And so, we see people, intracranial arterial stenosis or narrowing of the arteries inside of the brain is seen more commonly in African Americans compared to whites. Whites tend to have more extracranial carotid disease, so that’s carotid disease in the neck versus intracranially. But both are impacted by blood pressure as sort of that chronic pressure on the inside of the walls of the blood vessel. And so that can happen over time and the person doesn’t know it until he or she presents with that first stroke. And so, the impact of hypertension, in most people, it is silent. The most common symptom is to have no symptom. After that, some people may get headaches, and nosebleeds, and all kinds of other things but unfortunately, most people, by far, can’t tell you if their blood pressure is elevated or not. However, that elevated blood pressure is wreaking havoc on the arteries inside of your body - the brain, the heart, the kidneys, the eyes, various other organs. Host: Have you noticed any important trends, or noticeable trends, among your patient population? Dr. Benson: Well, I think obesity is probably the most notable trend, that people are overweight. And, unfortunately, people tend to wait before they come to the hospital. A lot of people, they try to wait to see if some of the symptoms of a stroke go away, so they choose to wait. And we know that time is brain. So, the longer you wait to come to the hospital, then the longer you prevent getting treatment that could restore blood flow to your brain and the more nerve cells that die. So people are tending to wait and not come to the hospital. And so that’s the other thing - that people are waiting to come to the hospital - we have to change that trend around. And people are not developing healthy lifestyles. And so those are two major trends that I think...and they’re both things that are changeable, that we can address. Host: So, there are some significant lifestyle changes - you’ve mentioned obesity. What are some of the lifestyle changes that people can make to improve their blood pressure? Dr. Benson: One of the major lifestyle factors that a person can do to change his or her risk factor for hypertension is to exercise. And the Northern Manhattan Stroke Study, which is the first stroke study that looked at a tri-ethnic community—blacks, whites and Hispanics—it found that people who exercise 20 to 30 minutes a day, three times a week have a lower rate of stroke compared to other people. So just moving for 30 minutes, three times a week. If you can do 30 minutes a day, that’s excellent, but just doing that minimum 30 minutes a day, three times a week, can lower your risk of stroke. So that’s one thing. The other is to institute a healthier diet. The, sort of, protocol diet that we talk about is the Mediterranean Diet, which is a diet that’s more full of fruits and vegetables, olive-oil based, and fish periodically - that’s sort of a healthier diet than a meat-based diet, fried diet, butter and other things, without a lot of dairy products as well. That’s sort of a healthier diet that someone can institute, as well as lowering stress as much as possible. I often get the question of how does stress play into stroke. We can’t take stress out of people’s lives, but it’s your response to stress. It’s important for people; if you get enough sleep, if you have ways of releasing stress—exercise is a good way to relieve stress, having good social support networks, being able to talk to someone, finding ways to meditate. If someone is a religious or spiritual person, to pray. To do a lot of other things in order to decrease stress—that’s another way to institute a behavioral change to decrease one’s risk of having high blood pressure or stroke or cardiovascular disease or heart attack. Host: So, for many people, exercise, diet, stress reduction, on its own, is not enough. What sort of medical therapies would you recommend to people if they really want to control their blood pressure?     Dr. Benson: Well, if someone tries all of those factors first—and it’s important to try first to institute behavioral changes to control blood pressure—and, in order to diagnose someone as having high blood pressure, normally we like to see three elevated blood pressures that are taken properly with someone sitting down after having rested. And I often try to, at least, check the blood pressure three times during one visit and then I can take the average of those blood pressures at that one visit and look at that as one encounter. And so, having three separate encounters with elevated blood pressure is what I would use to diagnose someone as having high blood pressure. And then instituting behavioral changes. If that doesn’t work, then it’s important to start with instituting medications. The American Heart Association has an algorithm that it uses, which is very clear in terms of which medication to start with, either starting with an ace inhibitor, which is a particular class of medication, or a diuretic or a beta blocker, depending on the risk factors for a particular person. African-Americans tend to be more sensitive to diuretics. In certain cardiovascular patients, beta blockers may work better. But beta blockers have certain side effects that work better in women versus men, so there are a lot of things to take into account. So, there are various types of medications that can be used, and it depends on the patient population. But one thing that we found, in terms of blood pressure control, there are different levels of intervention. We have interventions that are patient-level interventions - and some of those we talked about in terms of getting people to exercise more, to change their diet, to decrease their sodium. The other thing—there’s various platforms that people can use to log their blood pressures and to check them at least twice a month, and to follow their blood pressure. And just by checking your blood pressure with a monitor, there have been studies that have shown, if you do it for three months, you can get blood pressure under control. Those are patient-level interventions to get people to control their blood pressure. So, it’s important, when you think of interventions to control blood pressure, we don’t only look at interventions that impact the behavior of patients. There are also interventions that are very important that impact the behaviors of providers, medical providers, as well. In order to control blood pressure, we need coordinated efforts on the part of patients as well as physicians. And so, the American Heart Association is promoting Target BP, which is a program where providers are able to show, by submitting their blood pressure control rates, that they have greater than 70 percent of their patients who have blood pressure levels that are below target, and they’re incentivized by getting national recognition. And so that’s another method. And it’s important for providers to have some type of set algorithm for dealing with blood pressure, as well, so that they know how to change the medications and when to send the patient to a hypertensive specialist. I like to say that uncontrolled blood pressure is a doctor problem, not a patient problem. It’s important for doctors, or providers, including nurse practitioners or physician assistants, to also work very closely with their patients to get the blood pressure under control. Host: Could you tell us a little bit about what’s going on in your patients’ mind sets when they’re coming in, when they’re worried about their blood pressure and potentially their stroke risk? Dr. Benson: I think some people, they stay at home and they don’t come to the hospital when something happens acutely. They develop a new neurological symptom, and with stroke, some of the major symptoms—we think of the acronym FAST, which stands for, F is for face or facial weakness, A is for arm weakness, S is for speech problems, and T is for time, meaning call 911 immediately. 70 percent of all strokes will have one of these things, either facial weakness, arm weakness, or speech problems. Then we tell people to call 911. I think people notice the acute onset of some of the symptoms. They know something’s wrong, but they choose to wait and not come to the hospital, either because of financial reasons, that’s one. I don’t want to deal with the hospital bill. Time reasons - I don’t have time to wait in the emergency room; I know I’m going to be there for a long time. I don’t want the ambulance to come to my home so I’m not going to call 911. I don’t want to let my neighbors know what’s going on inside of my house. Or, I’m going to stay at home and I’m going to stick my head in the sand and it’s just going to go away. And so, all of those reasons. So, people tend to, unfortunately, a lot of people tend to not come to the hospital when these symptoms develop. But what they don’t realize is that if you don’t come in, then you’re going to lose a significant amount of brain cells every minute that you have a blockage of an artery in the brain. And so that’s significant. And so, the quicker the blood flow is reestablished, the better your chance of having recovery with less disability. And so we tell people to come in and to not think about those other things. So here, at MedStar Washington Hospital Center, if you come to the hospital in an ambulance, the stroke team will be called immediately. Here at MedStar Washington Hospital Center it’s called a code 1, and the stroke team will come and will take you back, do the imaging, and institute treatment as soon as possible. And so, it’s important to get to the hospital as soon as possible and get that acute treatment to save your brain cells. I think now stroke care has changed a lot since 2015. In 2015, there were five studies that showed the benefit of what we call embolectomy procedures, and that’s where interventionalists go through the groin and they go up to the brain and they remove clots from the brain to restore blood flow in less than six hours. Those studies showed the benefit of that procedure in patients less than six hours. In 2018, there were several studies presented at the International Stroke Conference in Los Angeles, in addition to new guidelines from the American Heart Association for treating stroke, that showed that now the standard of care is to do embolectomy procedures in select patients from six to 24 hours. And so that’s very new just in the last few months that that treatment, acute management of stroke, has changed. In the future, I think research is going towards neuroprotective agents. So, these are agents that we can use to protect cells that are at risk but have not gone on to become completely damaged. And so, here at MedStar Washington Hospital Center, we’re doing imaging studies with our MRI to sort of look at new ways that we can image cells that are at risk from 6 to 24 hours and hopefully, in the future, we will be able to participate or help to be a major force in looking for new and innovative ways of protecting those nerve cells that are at risk for damaging. Host: Why is MedStar Washington Hospital Center the best place for a person to seek hypertension care? Dr. Benson: Because of the fact that we have our state-of-the-art Cardiovascular Institute. We have providers here, cardiologists, who can institute the medical therapy that’s needed to get things under control. As well as, if a person has had a stroke, they can be seen by our vascular team, as well. If there are issues related to blood pressure control that impact the brain, the heart, or the kidneys, you can get coordinated care from all of the various specialties here at MedStar Washington Hospital Center. The more comorbidities, we call them, or the more diseases that someone has, it’s important to have coordination between specialists, and we have a lot of excellent doctors here and various specialists who work very closely with the internists in order to control medical care. And so, I think here, even though we are sort of a tertiary referral center, that it’s sometimes scary for people coming here—it’s hard to park, we’re in the middle of the city—but you’re going to have the right experts here to get your risk factors under control. So, I think, coming here, you have the best of everything that you need at your fingertips. Host: Thanks for joining us today, Dr. Benson. Dr. Benson: Thank you for having me. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

According to the American Heart Association/American Stroke Association, stroke is the number five cause of death and a leading cause of adult disability in the United States.On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and nearly 800,000 people suffer a new or recurrent stroke each year.Our Lady of Lourdes Medical Center, a leading provider for advanced stroke care, was recently designated as a Comprehensive Stroke Center by the New Jersey Department of Health. Lourdes is only one of 13 comprehensive stroke centers in the state to receive this designation.Listen in as Debbie Gillen MSN, explains how comprehensive stroke centers offer the highest level of care, with proven state-of-the-art technology, specialized testing, highly technical procedures and other interventions.

Approximately 800,000 people have a stroke each year; about one every 40 seconds. MedStar Washington Hospital Center is the first hospital in the Washington region to be certified as a Comprehensive Stroke Center by The Joint Commission. The Hospital Center joins an elite group of only 73 medical centers nationwide to receive this prestigious certification. Listen as Amie Hsia, MD, Medical Director of the Comprehensive Stroke Center at MedStar Washington Hospital Center, discusses what exactly happens in your body during a stroke, the ways we can stop it and the importance of receiving diagnosis and treatment quickly.

With advances in device design, patient selection paradigms and other elements of treatment, the neuroendovascular approach to acute ischemic stroke has made great strides forward. In this podcast, Dr Joshua Hirsch interviews Dr Brijesh Mehta on how the implementation of operational improvements can meaningfully impact patient outcomes. Dr Mehta is a neuroInterventional surgeon at the Memorial Neuroscience Institute in south Florida, where he directs the Comprehensive Stroke Center and Neurointensive Care Unit. These articles published in the JNIS might be of interest to people who enjoy this podcast: Applying the Lean management philosophy to NeuroInterventional radiology http://goo.gl/c0x5Zl Establishing operational stability—developing human infrastructure http://goo.gl/623WtS ‘Time’ for success http://goo.gl/rgJ0U7