STROKE AND VASCULAR DISEASE
Emergency treatment for stroke is essential to save lives and preserve function, but follow-up care is vital to ensure the fullest possible recovery. “Stroke patients need to be seen over time after the acute event,” says David Liebeskind, MD, director of the UCLA Stroke Center. At UCLA, “we develop ongoing partnerships with community physicians to provide expertise and ensure that their patients receive the long-term follow-up that will optimize outcomes.”
The UCLA Stroke Center provides comprehensive diagnostic and therapeutic care for simple and complex vascular disorders through multidisciplinary teams that work closely with patients and their referring physicians. “We offer the expertise not just of individuals, but of our center as a whole,” says UCLA neurosurgeon Geoffrey Colby, MD, PhD. “A good part of the success of the procedures we perform comes from the care that’s provided before and after, through the immediate recovery period and beyond.”
In many cases, it pays to not wait for an acute event. For example, when a patient is found to have intracranial atherosclerotic disease (ICAD) — the narrowing of the large vessels of the arteries leading to the brain, putting them at risk for stroke — early referral to an expert center is important, in part because the best course of therapy isn’t always clear.
Beyond managing patients, the center advances clinical care as a leader in research. Dr. Liebeskind heads a number of ICAD studies to learn more about stroke risk and the impact on cognitive function. Using detailed longitudinal imaging studies, for example, his group is examining how physical activity affects blood pressure and other risk factors to prevent stroke. Through computational fluid dynamics, he and his colleagues are learning how the specific architecture of the narrowing of the vessels might affect stroke risk. Dr. Liebeskind also heads a large NIH-funded study of patients with asymptomatic carotid disease to better understand how blood flow relates to cognition over time, and the potential impact on dementia risk.
The center’s neurosurgeons treat patients with complex vascular lesions, often using revascularization to avert ischemia and then following patients at all stages of the disease. One example of this approach is for Moyamoya disease, a rare, progressive cerebrovascular condition that is one of the primary causes of stroke in children and young adults. “These are usually young people, and often children, who are seemingly healthy; then they suffer a stroke and are at high risk for strokes in the future,” says neurosurgeon Anthony Wang, MD, who specializes in cerebrovascular, pediatric and complex cranial-base surgeries. “Our goal is to correct the chronic lack of oxygenation to the brain, and prevent that damage from occurring for the rest of that individual’s life.”
“We’ve learned a great deal through studies showing that having the full arsenal of surgical techniques is important, given that these patients present differently, and that certain presentations or anatomies respond better to certain treatments,” Dr. Colby adds.
Stroke is rare in the overall pediatric population, and the UCLA Stroke Center stands apart for being staffed with experienced neurologists, neurosurgeons and radiologists who subspecialize in treating pediatric stroke, both in the acute and outpatient settings. “It can be challenging to recognize the signs of stroke in children, as the overall incidence is low and the clinical presentation can be nonspecific, particularly in infants,” neurologist Latisha Sharma, MD, says. Once the acute care is completed, access to a team with a multifaceted approach to outpatient treatment of the child in ensuing years plays an essential role in his or her recovery, Dr. Sharma says.
Although stroke is the third-leading cause of death among women in the United States, Dr. Sharma notes that the symptoms can be subtle and are more likely to be missed or minimized by women than men. “We need to do more to educate women to call 911 and not delay seeking treatment especially if there is a sudden neurological change,” she says. Women may be at higher stroke risk in the antenatal and postpartum period from conditions such as preeclampsia. “Preeclampsia is considered a sex-specific risk factor for future stroke but is often underrecognized and many women are unaware of their risk later in life,” Dr. Sharma adds.
Another example of the center’s comprehensive, long-term management approach involves patients with intracranial aneurysms. “These are patients who need to be followed for life, both to make sure that whatever treatment is offered is durable and to screen them to ensure they’re not developing new aneurysms,” Dr. Colby says.
Once patients are diagnosed with a cerebral aneurysm — typically following a workup for an unrelated symptom — the decision on how to manage it isn’t always straightforward, Dr. Colby notes. Treatment options can include several types of open surgery, as well as a host of minimally invasive endovascular options. Offering the full array of treatment options along with advanced imaging capabilities to guide the decision-making process, the UCLA Stroke Center is well positioned to take on these cases and to provide a customized solution for each patient. “We have multidisciplinary conferences that include specialists in neurosurgery, neurointerventional radiology and cerebrovascular neurology in which we make sure our patients receive optimal management,” Dr. Colby says. “The only way you can do that is if you offer everything and don’t have any biases about one procedure or another.”