Patients are referred from around the world to the UCLA Stroke Center and receive comprehensive evaluation by a team of specialists that includes stroke neurologists, vascular neurosurgeons, interventional neuroradiologists, emergency physicians, and rehabilitation physicians. Patient services are coordinated through the Neurovascular Clinic, the Stroke Prevention Clinic, and the Cerebral Blood Flow Laboratory.
The Stroke Center's programs include the following:
Patients can participate in clinical trials of multiple novel clot dissolving regimens and neuroprotective agents, and a UCLA study of neuroperfusion (a procedure that reverses blood flow through cerebral veins). These trials are supported by the National Institute of Health, nonprofit organizations, and pharmaceutical sponsors.
UCLA was the first center in the United States to participate in a randomized, controlled trial of carotid and vertebral artery angioplasty. Additional trials of combined angioplasty and stenting are planned for initiation in the next two years.
It's not just called stroke any more. Now, the term is "Brain Attack," words chosen to convey not only the severity of the problem, but also the urgency. New medications and interventions can minimize damage to the brain, with dramatic results for stroke patients, if help is sought in time. The window of opportunity: only minutes to hours from the time of the attack.
The UCLA Stroke Center's Brain Attack Team includes: emergency neurology, Dr. Sidney Starkman; stroke neurology, Drs. Jeffrey Saver, Latisha Ali, Doojin Kim, David Liebeskind, and Bruce Ovbiagele; critical care neurology, Dr. Paul Vespa; vascular neurosurgery, Drs. Neil Martin and John Frazee; neurological rehabilitation, Drs. Bruce Dobkin and David Alexander; interventional neuroradiology, Drs. Fernando Vinuela, Gary Duckwiler, Nestor Gonzalez, Reza Jahan and Satoshi Tateshima. "The range of our expertise in the area of stroke medicine is truly unparalleled in the country," said Starkman. "And so is our productivity in terms of research and clinical advances."
In the intensive care unit and operating room, the Stroke Center is developing new computerized techniques of continuously monitoring cerebral physiology employing evoked potentials, electroencephalographic frequency trending, transcranial Doppler ultrasound, and xenon-133 cerebral blood flow. Remote brain monitoring is being developed to allow Internet access to physiological recordings.
Detection of ischemia and vasospasm by transcranial Doppler ultrasound, TCD embolus detection, and xenon blood flow in OR, ICU, and endovascular procedure suite.
The Stroke Center is supported by one of the world's busiest clinical/research cerebral blood flow laboratories. The CBF Laboratory has demonstrated that patients' cerebrovascular status can be precisely quantified using transcranial Doppler, xenon-CT, and, in selected cases, PET scanning. Continous recording of brain blood flow and metabolism in the operating room and the ICU is being optimized using a newly developed transcranial Doppler monitoring package and jugular bulb oximetry. NIH-supported cutting-edge research is being conducted on brain-injury-induced cerebrovascular and metabolic pathology.
Cutting edge neuroimaging techniques are being used to evaluate patients with cerebrovascular disease at UCLA. These include Diffusion/Perfusion MRI which shows signs of an actue infarct within minutes of symptom onset.
For continuous monitoring during embolization, neurosurgery, and intensive care.
Guido Guglielmi, M. D., Ph.D., developed at UCLA the GDC (Guglielmi detachable coil), now a standard alternative or supplement to neurosurgery for the treatment of brain aneurysms. New coils are being created and refined. The Stroke Center's interventional neuroradiology program is also developing novel catheters, alloys, and techniques for occluding abnormal cerebral vessels and reopening stenoed vessels. Advanced computer modeling of aneurysms is being pioneered to enable virtual reality aneurysm investigation and treatment.
For embolization of complex intracranial and spinal vascular malformations and tumors, cerebral angioplasty, and intra-arterial thrombolysis.
For defining anatomy and physiology of cerebrovascular disorders by MR (diffusion, perfusion, spectroscopy, angiography), xenon-CT, 3-D CT angiography, PET, and super-selective angiography.
The Stroke Center is at the forefront in translating recent remarkable advances in understanding the molecular basis of ischemic neuronal injury into practical clinical therapies. Patient trials of seven promising neuroprotective agents have been conducted in the last two years, with promising results. Pivotal phase III trials of favorable agents and combined thrombolytic-neuroprotective trials will be carried out during the next two years.
For cerebral arterial bypass procedures, carotid endarterctomy, and surgical treatment of aneurysms and vascular malformations.
Interventions are designed to improve recovery of walking, use of the arm, speech, and other disabilities.
For small inoperable AVMs or in combination with embolization and surgery for large AVMs.
UCLA's Young Stroke Clinic offers comprehensive assessment and treatment for individuals under age 45 with stroke/TIA.
State-of-the-art evaluation and intervention for individuals of any age at increased risk for ischemic and hemorrhagic stroke.
A new three-minute screening test that detects one-sided motor paralysis allows paramedics and other first-responders to rapidly identify people experiencing a stroke, and may soon enable on-the-scene treatment with drugs that can limit the potentially extensive damage caused by these "brain attacks." The screening test, developed at UCLA, can shorten the time to actual treatment by an average of 90 minutes.
UCLA is a leading center worldwide in developing thrombolytic ("clot-busting") therapies for acute ischemic stroke. Studies planned for the coming year include protocols to enhance vessel recanalization and patient outcome by delivering tPA through both intravenous and intra-arterial (catheter-administered) routes.