The Comprehensive Stroke Program within the Department of Neurology at Wayne State University is one of the leading stroke programs in the United States. It is currently staffed by five vascular neurologists, two faculty in the associated neurocritical care program, one interventional neurologist, 1-2 vascular neurology (stroke) fellows, and two nurse coordinators.

 

The Comprehensive Stroke Program continues to serve as a regional leader in clinical research seeking to identify the optimal treatment modalities for patients with acute stroke and treatment strategies for stroke prevention. Over 1000 patients with stroke are seen each year in the outpatient vascular neurology clinic and over 400 per year are seen as inpatients. The outpatient stroke clinic serves as a referral center for patients from all parts of Michigan. The acute stroke team evaluates patients at the downtown Detroit Medical Center hospitals for acute treatment with “clot-busters” or other modalities. The acute stroke team’s capabilities were essential in the designation of Detroit Receiving Hospital as a JCAHO-certified primary stroke center. Since 2007, Sinai-Grace Hospital and Huron Valley Hospital have been covered by the Acute Stroke Team via telemedicine (see below).

 

In the research area, previous and current funding has included attempts to identify African Americans at increased risk for stroke as well as efforts to improve the quality of stroke care in Michigan and nationally. We have participated in several prominent clinical trials which have evaluated new strategies for stroke prevention and these studies have been published in reputed journals such as the New England Journal of Medicine and Journal of the American Medical Association. Current areas of research are investigating placement of stents in narrowed blood vessels inside the skull to prevent stroke and also investigation of new blood thinners for stroke prevention. A novel medication is also being tested to promote motor recovery from a recent stroke.

 

Seemant Chaturvedi, M.D., Director of the Comprehensive Stroke Program, was an investigator in the SPARCL study, which was published in the New England Journal of Medicine in 2006. This was the first study to show that statin medications are useful for preventing stroke in patients with a previous stroke or mini-stroke and no evidence of heart disease. Dr. Chaturvedi is also on the executive committee of the SAMMPRIS study, a new NIH-funded study to compare intracranial stenting vs. aggressive medical management for patients with symptomatic intracranial blockages.

 

 

Kumar Rajamani, M.D. is the WSU principal investigator for a Blue Cross Blue Shield of Michigan Foundation sponsored study looking at quality and delivery of acute stroke care in several hospitals in Michigan. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in collaboration with the American Heart Association (AHA)/American Stroke Association (ASA) has developed performance measures for Certification as Primary Stroke Centers. With the addition of Tele Stroke services, we plan to get the other DMC hospitals certified in the near future as Primary Stroke Centers. The study aims to compare acute stroke care delivered in JCAHO certified Primary Stroke Centers versus that in non-certified hospitals.

 

Ramesh Madhavan, M.D. is leading the effort for the incorporation of telemedicine, which has developed nationally and internationally as a reliable means of treating acute stroke patients.  Wayne State University/DMC’s System wide stroke initiative is one of the few Stroke networks in the country that use the hub and spoke model for providing comprehensive stroke care in the Mid-West. The new paradigms in stroke care that went live in September 2007 include Tele-Stroke and the use of System wide EMR based order sets. The WSU/DMC Stroke team consisting of Vascular and Critical Care fellowship trained neurologists has been providing acute stroke coverage for DRH and Harper University Hospital since 1996. When the Stroke pager is activated, the patient is assessed on site by the Stroke team 24/7 and patient managed. The same principle is applied at off-site Community hospitals; Sinai Grace and Huron Valley Hospital using telemedicine as a bridge. The patient is examined by one of the eight stroke team attending physician with the help of a remote Tele-presence robot and the onsite ED physician. Images and results are seen remotely by the Stroke Neurologist and treatment decisions made. More acute Stroke patients have received tPA, the only FDA approved clot busting treatment in the DMC hospitals during the past year. Over the past 18 months, the project has been found to be effective and improved stroke care and outcomes in all the participating hospitals. 

 

Sunitha Santhakumar, M.D. is participating in the Small Subcortical Stroke prevention study and is leading outpatient efforts in the Neurology Department.

 

The Neurocritical Care Unit at Detroit Receiving Hospital is one of the leading Neurocritical Care programs in the country. Led by William Coplin, M.D., the neuro-intensive care unit (NICU) serves as a regional resource for patients with traumatic brain injury, hemorrhagic stroke, large ischemic strokes, and other life-threatening neurologic illnesses. The NICU is currently engaged in studies focusing on several areas, including novel treatments for brain hemorrhage and traumatic brain injury. Dr. Coplin is a board member of the NeuroCritical Care Society. Greg Norris, MD  joined the neurocritical care staff in 2007. He and Dr. Coplin are a tremendous resource for the region’s sickest neurological patients.

 

Andrew Xavier, M.D., jointly appointed in the Departments of Neurosurgery and Neurology, is an interventional neurologist and serves as a key resource for treatment of patients with ischemic or hemorrhagic stroke. Dr. Xavier is leading the efforts to study mechanical devices for acute stroke treatment. Since the overall treatment for stroke is increasingly focusing on endovascular treatment, the addition of Dr. Xavier has been very significant for the Stroke Program. Having an interventional neurologist is rare at Southeast Michigan hospitals and is a key distinguishing factor in our program.