Beyond Stroke: A comprehensive approach to cerebrovascular care

While the term “stroke” often dominates discussions around cerebrovascular events, it’s also shorthand for the expansive work that’s being done at UT Southwestern’s Robert D. Rogers Advanced Comprehensive Stroke Center, where the team is dedicated to addressing a wide array of cerebrovascular diseases that impact the brain’s blood vessel system. Focusing solely on the word stroke can understate the comprehensive care and cutting-edge research the Robert D. Rogers Stroke Center provides for the conditions that fall under this specialty.

“We’ve married neurology, neurosurgery, neurorehabilitation, and neurocritical care for years and that, along with adding radiology and research, has revolutionized patient care and set the highest standards for this field of work,” said Mark Johnson, M.D., Professor of Neurology.

Challenging traditional methods

The focus on the stroke aspect of cerebrovascular diseases has become so predominant that many doctors are only proficient in handling the procedural part of these medical emergencies. UT Southwestern stands out by developing comprehensive programs addressing a wide range of cerebrovascular diseases – from preventive measures all the way through recovery.

“For us, being part of this Center means constantly improving with a focus on multidisciplinary treatment pathways so that we can not only treat common conditions but also rare diseases of the cerebrovascular system,” added Babu Welch, M.D., Professor of Neurological Surgery and Radiology.

Dr. Johnson, a neurologist, and Dr. Welch, a neurosurgeon, were drawn to UT Southwestern for its exceptional collaboration and multidisciplinary approach – a trademark characteristic that continues to differentiate the medical center and shape its advanced, comprehensive approaches to patient care, even when it defies traditional approaches.

“Our strength lies in the fact that neurologists, physiatrists, nurses, radiologists, neurosurgeons, and critical care doctors all work together, routinely meeting to coordinate patient care,” said Dr. Welch, who holds the Duke Samson Chair of Neurological Surgery at UT Southwestern. “It’s not just about performing a single procedure or prescribing one medication. It’s about the entire process – from admission to discharge – and ensuring patients leave in a way that reduces the likelihood of readmission.”

Delivering research-driven care

UT Southwestern is a premier research institution with clinical providers who are continuously learning, advancing, and delivering exceptional care. More patients are choosing UT Southwestern because it promotes partnership among top specialists, providing state-of-the-art facilities matched with expertise to ensure effective disease management. Feedback from patients is overwhelmingly positive.

“We recently had a patient with a particular brain finding that led to some debate over the appropriate medication among other physicians,” Dr. Johnson said. “Our team took the time to explain everything in detail to the patient from the beginning. By the end of the visit, she had a much deeper understanding of her condition and truly appreciated being heard.”

UT Southwestern has been a leader in the latest techniques and technologies for surgical and endovascular treatments of stroke, aneurysms, and arteriovenous malformations (AVM) for decades.

“We’ve built two specialized operative suites in both of our hospitals that combine radiology and surgical techniques, allowing for less invasive and more direct treatments,” Dr. Welch said.

Clinical trials and research have been pivotal. Traditional methods for treating subdural hematomas over the brain, for example, have been challenged.

Historically, these blood clots have been removed by taking out bone to get access to blood on the surface of the brain. These patients typically remain in the hospital or intensive care unit for two weeks with drains in their heads, and they often have to return for follow-up treatment, Dr. Welch said. But middle meningeal artery (MMA) embolization is reducing recovery times and improving efficacy.

“With MMA embolization, we can block the vessels that create or cause the recurrence of subdural hematomas through a less invasive procedure via the groin, yielding incredible results,” Dr. Welch said.

Patients can be mobilized and discharged within a few days. Over the past year, three trials have demonstrated the efficacy of this approach, showing that patients fare well without the need for open surgery, he added. 

In addition, research studying the side effects of obesity has revealed that young obese women with headaches, vision changes, and ringing in the ears may be suffering from idiopathic intracranial hypertension, previously known as pseudotumor cerebri (PTC). For many of these patients, this is the result of brain pressure and narrowing of the large veins that drain the brain, also known as venous sinuses. But through interventional techniques available at UTSW, these patients are finding relief.

“Not only can we better understand the condition by measuring pressures and narrowings in the veins, but we can also open these narrowings through less invasive procedures via the groin,” Welch explained.

Improving outcomes

Advances in neuromodulation technology are enabling the team to work within the veins to implant electrodes or stent rods. There is promise that these electrodes can stimulate brain areas surrounding the veins, offering potential treatments for conditions such as amyotrophic lateral sclerosis (ALS) and stroke recovery. This minimally invasive care utilizes interventional techniques to resolve brain blood clots and modify brain responses or interfaces, representing a significant advancement.

An international research study is exploring the cascade of blood coagulation to test the efficacy of a new blood thinner called asundexian, a factor XIa inhibitor. This study, led locally by Principal Investigator Ty Shang, M.D., Ph.D., Associate Professor of Neurology, aims to determine if asundexian and other agents can prevent stroke recurrence without increasing the risk of bleeding.

UT Southwestern is also making advances in direct patient care. Rapid response nurses play a crucial role in stroke care within the hospital, promptly assessing patients and, when they suspect a stroke, activating a code stroke to ensure immediate intervention. Published data by UTSW researchers highlight these life-changing interventions and demonstrate their efficacy in advancing patient care with clot-busting treatments.

“Our nursing care with rapid response capabilities enables us to act and move faster, allowing teams to integrate and respond in near real-time,” Dr. Johnson said.

Shaping the future

The Robert D. Rogers Advanced Comprehensive Stroke Center is a large referral center for treating moyamoya disease and syndrome in patients with congenital or disease-related (e.g., diabetes, hypertension) narrowing of blood vessels leading to recurrent strokes. The specialized team includes surgeons skilled in creating new blood vessels or bypasses and neurologists for medical care and evaluation. The Advanced Imaging Research Center (AIRC) facility at UT Southwestern allows the cerebrovascular team to support studies funded by the National Institutes of Health on techniques to assess blood flow during diagnosis and treatment. Reflecting the Center’s comprehensive focus, this integration of clinical and radiology teams enables access to less invasive and more efficient patient care for those with this devastating disease.

The myriad advancements at the Rogers Stroke Center underscore a critical point: Concentrating on stroke alone overlooks the vast landscape of cerebrovascular diseases and the extensive opportunities for prevention and improved patient outcomes. The Center’s commitment to collaboration, cutting-edge research, and a holistic approach is grounded in the latest scientific findings and the highest standards of care. Internationally and nationally recognized, this exceptional team led by Dr. Johnson and Dr. Welch is not only setting the bar for national guidelines, but also shaping the future of cerebrovascular care for patients everywhere.