Neurovascular

The Neurovascular Division of the Department of Emergency Medicine

The Neurovascular Division of the Department of Emergency Medicine performs both basic science and clinical research on neurovascular emergencies. We also offer the first neurovascular fellowship for emergency medicine trained physicians. Finally we offer rotations for emergency medicine residents to participate with the Greater Cincinnati/Northern Kentucky Stroke Team.

The Neurovascular Division currently has the following members:

The emergency medicine faculty and staff are integral members of the Greater Cincinnati/ Northern Kentucky Stroke Team. This is one of the most active stroke research teams in the world. Built on a long-standing multidisciplinary collaboration this team features immediate consultation for acute stroke patients for all 15 acute care hospitals in the Greater Cincinnati/Northern Kentucky region. With both vascular neurologists and emergency physicians sharing primary call this team treats an average of over 120 patients per year with reperfusion therapies. These therapies range from intravenous t-PA to intra-arterial approaches. The team also enrolls more than 50 patients per year in acute stroke treatment trials.

Ongoing Projects with Emergency Medicine Principal Investigators Include:

The Combination approach to Lysis utilizing Eptifibatide And Rt-PA (CLEAR) stroke trial. Dr. Pancioli is the PI of this multi-center, randomized, double blind, sequential, dose-escalation safety study of the combination of IV eptifibatide and IV low-dose rt-PA in acute ischemic stroke patients. The goal of this trial is to obtain reliable estimates of the safety of a glycoprotein IIb/IIIa antagonist, eptifibatide in combination with low-dose rt-PA in acute stroke patients in whom treatment is begun within three hours of symptom onset. The trial is funded by the NINDS ($2.1 million direct cost) and is being done at 10 centers across the United States. Our research in the Proteomics of Acute Ischemic Stroke is lead by Dr. Edward Jauch. This research employs both traditional serum ELISA assays for known serum markers of CNS injury and a functional proteomics approach to identify serum proteins that are associated with both the presence of ischemia and intracerebral hemorrhage following treatment within the CLEAR Trial. Pretreatment and post-treatment serum samples from patients who have an intracerebral hemorrhage after thrombolytic and antiplatelet treatment will be compared to samples from similarly treated patients who do not develop intracerebral hemorrhage. A long-term goal of this study is to develop serum marker assays to improve patient selection for thrombolytic therapies in acute stroke. Additionally, the proteomic protein library created by this project could help identify new proteins associated with ischemic stroke leading to improved diagnostic assays with increased sensitivity, specificity, and accuracy for cerebral ischemia. This study is funded by the NINDS ($1.3 million direct cost). Dr. George (Chip) Shaw heads our basic science laboratory and has developed one of the premier models in the world to evaluate the effect of ultrasound on thrombolysis. It has been known for some time that ultrasound can enhance the action of thrombolytic medications including rtPA. However, the basic mechanism is not well understood. Dr. Shaw is currently performing research funded by a Whitaker Foundation Biomedical Engineering Research Grant ($227,000) to study this phenomenon at the microscopic level in the hopes of gaining insight into the mechanisms responsible for ultrasound enhanced thrombolysis (UET). In addition, Dr. Shaw was awarded a grant ($25,000) from the Neuroscience Institute (TNI) in 2002 to examine the effects of clot age on the thrombolytic efficacy of rt-PA and rt-PA with adjunctive ultrasound on human whole blood clots. This work is coming to fruition and insight into this problem will improve the understanding of UET Finally, the effects of rtPA concentration, temperature and other adjunctive therapies such as GP IIb/IIIa inhibitors are being studied in this highly reproducible model to provide the first ever series of quantitative data on rates of thrombolysis.

Collaborative research efforts from the Neuroscience Section include ongoing research projects with the Mayerson Center for Child Abuse at Children’s Hospital, the Department of Obstetrics and Gynecology investigating antiphospholipid antibodies in the involvement of stroke, and the Departments of Neurology and Neurosurgery, and Molecular and Cellular Physiology at the University of Cincinnati College of Medicine.

The Neurovascular Fellowship:

This fellowship provides the Emergency Medicine residency graduate with training in acute neurovascular emergencies in collaboration with the Greater Cincinnati/Northern Kentucky Stroke Team. This training is accomplished through clinical experience involving acute stroke intervention at The University of Cincinnati and other regional hospitals, as well as through didactic education in research methodologies, biomedical statistics, and principles of research design. Additional training will be provided by the Department of Neurology and the division of Neuroradiology in the utilization of neuro-imaging, including CT, MRI, MRA and transcranial doppler. The fellow also directly participates in stroke call and ongoing acute interventional trials.

Starting in July, 2006 we will have 2 fellowship positions (already filled for 2006) for a two-year fellowship that will combine the traditional 1 year neurovascular fellowship with an additional year of neuro-critical-care.

Opportunities for Emergency Medicine Residents:

The Neurovascular division has a long history of providing opportunity to emergency medicine residents who wish to acquire experience in neurovascular research or the acute clinical management of neurological emergencies. Residents can join research projects or rotate with the stroke team treating acute stroke patients with reperfusion therapy (averaging greater than 100 calls per month and greater than 10 t-PA treats per month).