4 CLINICAL NEUROSCIENCES UPDATE SUMMER 2018 4 CENTERING ON STROKE SURVIVAL CONTINUED FROM PAGE 3 both general consultation on stroke care and prehospital evaluation of stroke patients. Those patients deemed candidates for advanced treatment at UMMC’s CSC are expedited via land and air interhospital transport to the Medical Center, where BAT neurologists work closely with the neuro-interventional radiology team to make clinical decisions about patient treatment based on imaging diagnostics. Before and after their treatment, patients receive expert care in UMMC’s 22- bed Neurological Critical Care Unit (NCCU) UMMC under the direction of Neeraj Badjatia, MD, MS and staffed by 13 dedicated advanced practice providers, 75 neuroscience nurses, four United Council for Neurological Subspecialties (UCNS) fellows in neurocritical care, and seven neurocritical care trained faculty from Neurology, Emergency Medicine, Anesthesiology, and Neurosurgery. In the case of a major stroke, the therapeutic time window in which emergent care must be delivered to prevent disability or mortality has expanded. “The efficacy of stroke treatment traditionally has fallen within a six-hour window,” says Dheeraj Gandhi, MBBS, Professor of Diagnostic Radiology and Nuclear Medicine and CSC Executive Committee member. “However, recent guidelines issued by the American Heart Association and American Stroke Association indicate that a mechanical thrombectomy could benefit certain acute stroke patients up to 24 hours.” The ability to perform mechanical thrombectomies for stroke patients is a key requirement of a comprehensive stroke center. UMMC’s CSC has four board-certified interventional neuroradiologists who are on call 24/7 to evaluate a stroke patient for mechanical thrombectomy. “It can take less than an hour to complete this procedure,” notes Dr. Gandhi. “In terms of recovery, 40-50 percent of patients walk out of the Medical Center within two to three days. It is a transformative treatment.” When additional advanced lifesaving procedures are called for, Neurosurgery’s skilled neurosurgeons (E. Francois Aldrich, MB, ChB; Elizabeth J. Le, MD; and J. Marc Simard, MD, PhD) specialize in treating complex conditions involving stroke, aneurysms, and other cerebrovascular disorders. They also partner with the UM Gamma Knife Center—the first center of its kind in the Mid-Atlantic—a revolutionary, non-invasive surgery that has proven effective for arteriovenous malformations and certain brain tumors. And for stroke patients in recovery, the University of Maryland Rehabilitation & Orthopaedic Institute offers a comprehensive, interdisciplinary and individualized Stroke Rehabilitation Program, designed to help stroke patients recover and maximize their potential based upon their diagnosis and goals. Preventing the Next Stroke Along with the exceptional clinical treatment for stroke, a parallel priority of the CSC is stroke prevention through a range of clinical and outcomes research studies. “We believe that part of our responsibility is to participate in clinical research that advances immediate clinical care,” says Steven J. Kittner, MD, MPH, Professor of Neurology and Chief of the Division of Stroke and Cerebrovascular Diseases. Dheeraj Gandhi, MBBS performs a mechanical thrombectomy, employing sophisticated neuro-imaging to thread a catheter up through a major artery to remove a blood clot blockage in the brain. Even major strokes can be treated successfully through this new, highly advanced procedure.