Accelerating Cures by Three Stages of Care and Research

The Stroke & Applied NeuroScience Center is committed to improving the lives of our patients before, during, and after hospitalization for stroke and other neurological conditions.

BEFORE:
Develop early detection and diagnosis to understand the the underlying cause of stroke and other neurological conditions through novel minimally-invasive techniques and machine learning.

DURING:
Advance the treatment of stroke and neurological conditions through computational surgical simulations and medical device development.

AFTER:
Improve quality-of-life for our patients after they leave the hospital through addressing the medical and mental health burden following stroke and other neurological conditions.

Support the SANS Center in discovering ways to understand, treat, and prevent stroke, cerebrovascular disease, and other neurological conditions.

Research Projects

This is a listing of the SANS Lab’s current research projects. Click on neurological conditions below to see a list of projects in that topic area.

Ischemic Stroke

Hemorrhagic stroke/aneurysms/vascular malformations

Traumatic brain injury

Neurodegenerative disorders

Ischemic Stroke

Hemorrhagic stroke/aneurysms/vascular malformations

Traumatic brain injury

Neurodegenerative disorders

MRI for Idiopathic Intracranial Hypertension and other CSF pathologies

This research work targets the contribution of cerebrovascular pathology to idiopathic intracranial hypertension (IIH) otherwise known as pseudotumor cerebri. Cerebrovascular abnormalities often mimic symptoms of IIH and are also found coincident with the disease. It is unclear what specific vascular abnormalities are in subjects with true pseudotumor. The objective of this study is to address this knowledge gap by refining non-invasive vascular MRI techniques.

Cerebral aneurysm risk stratification using hemodynamic modeling and endothelial genetics

This study will investigate diseases of the brain and its blood vessels to identify the hemodynamic factors associated with treatment success or failure after cerebral angiograms for stroke and hemorrhage, while in parallel interrogating the genetic and molecular biology of the disease mechanisms. This project is supported by an Institute of Translational Health Sciences Research Innovation Award.

Endovascular biopsy for the investigation of the genetics and basic biology of diseases of the brain and its blood vessels

With the support from the BEE Foundation, we will research the genetics and molecular biology of cerebrovascular diseases to understand disease mechanisms and propose novel therapies. We will collect tissue from a variety of cerebrovascular diseases from surgery that is excess of the needs of diagnostics, we will collect catheters used in angiograms and surgeries, as well as coils, blood, and medical records, for experiments on DNA, RNA, and protein, and computational fluid dynamics.

Genetic and hemodynamic parameters of intracranial aneurysm treatment outcomes, formation, and rupture

This study, funded by the University of Washington Office of Research Royalty Research Fund (RRF), is an expansion of our Model Seeding and Endovascular Biopsy projects. This study will investigate diseases of the brain and its blood vessels to identify the hemodynamic factors associated with treatment success or failure after cerebral angiograms for stroke and hemorrhage, while in parallel interrogating the genetic and molecular biology of the disease mechanisms.

Computational fluid dynamics of Alzheimer’s disease

The cerebrospinal fluid (CSF) in patients exhibiting Alzheimer’s disease (AD) is observed to contain plaques and tangles of AD-related molecules that alter brain tissue. Prior studies found that that a CSF shunt placement reduced the presence of AD-related proteins. We hypothesize that a computational method of determining the CSF-related stresses on surrounding brain tissue would permit noninvasive, early diagnosis of AD and mild cognitive impairment (MCI).

EMBOLISE: Embolization of the Middle Meningeal Artery with ONYXTM Liquid Embolic System (LES) In the Treatment of Subacute and Chronic Subdural Hematoma

The study is a prospective, multi-center, randomized, interventional, open label, controlled medical device clinical study, sponsored by Medtronic, evaluating the performance of the Onyx™ LES for MMA embolization for patients with symptomatic subacute or chronic subdural hematoma (SDH). The Onyx™ LES for embolization of MMA is investigational in the US. The objective of this Medtronic-sponsored study is to evaluate the safety and effectiveness of Onyx™ LES embolization of the middle meningeal artery (MMA) as adjunct to conventional treatment (surgery or observation) for symptomatic subacute or chronic subdural hematoma. Patients who are diagnosed with subacute and chronic subdural hematoma will be enrolled in this study.

MIND: A Prospective, Multicenter Study of Artemis a Minimally Invasive Neuro Evacuation Device, in the Removal of Intracerebral Hemorrhage

MIND, sponsored by Penumbra Inc., compares the safety and efficacy of minimally invasive endoscopic surgical treatment with the Apollo / Artemis Neuro Evacuation Device for supratentorial intracerebral hemorrhage to standard medical management. The expectation is that patients treated with the minimally invasive Artemis Device have better outcome as demonstrated by their surveyed quality of life. Patients diagnosed with intracerebral hemorrhage will be enrolled in the study.

INVEST Feasibility: A Single Arm, Study of Minimally Invasive Endoscopic Surgical Treatment with Apollo/Artemis for Supratentorial Intracerebral Hemorrhage

INVEST Feasibility is a Mount Sinai physician led, multicenter single-arm feasibility study that intends to provide an assessment of enrollment and follow-up feasibility for patients who present with a supratentorial intracerebral hemorrhage (ICH) and are being treated with the Apollo or Artemis Minimally Invasive Surgical Treatment (MIES) through neurological and functional assessments. Patients who are unable to be enrolled in the feasibility study are referred to the INVEST Registry study, where patients are only responsible for completing the assessments and are not treated with the Apollo or Artemis MIES.

OPEN-UP: Operative Procedures vs. Endovascular Neurosurgery for Untreated Pseudotumor

Working in tandem with Barrow Neurological Institute/Dignity Health, this study aims to determine whether dural venous sinus stenting is as safe and effective as cerebral spinal fluid (CSF) shunting in halting or improving moderate-to-severe visual loss in patients with idiopathic intracranial hypertension (IIH). Patients diagnosed with intracranial hypertension as well as moderate to severe visual loss will be included.

Autologous Mitochondrial Transplant for Ischemic Stroke

Disruption of the cerebral blood flow during acute ischemic stroke disrupts oxygen and glucose delivery to cells, leading to injury of cellular organelles such as mitochondria. Mitochondrial dysfunction has been recognized as one of the major contributors to neuronal death after stroke. We are studying a treatment called mitochondrial transplant, where a patient’s healthy mitochondria are injected into an artery in the brain that supplies tissue damaged from an ischemic stroke. This treatment is based on a biological process called mitochondrial transfer which occurs naturally between different brain cell types during stroke. The objective of this first-in-human-brain study is to understand if the healthy transplanted mitochondria are safely incorporated into the damaged brain cells, limit or prevent further neuronal injury, and possibly even restore function to damaged brain. This University of Washington will be the first institution to study this treatment in human stroke patients. To learn more, please visit: https://clinicaltrials.gov/ct2/show/NCT04998357

In vitro medical device testing

Our lab has developed a proving ground for newly developed endovascular medical devices. We are able to treat 3D–printed models of common cerebrovascular diseases (such as aneurysms or arteriovenous malformations) with medical devices the same way they would be used in surgery. We then use a suite of benchtop and computational methods to test the efficacy and safety of these devices. This suite includes computational fluid dynamics, particle image velocimetry, microtomographic imaging, and genetic testing of models lined with vascular cells.

Viral reactivation from ganglia in subarachnoid hemorrhage

Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating disease frequently leading to death or poor functional outcome. A major complication of aSAH is the development of cerebral vasospasm, which is defined as narrowing of the large and medium-sized intracranial arteries. In this NIH-funded study, we are studying changes in the blood flow velocity and/or caliber of the cerebral vessels and their relationship to viral shedding from saliva and tears. Such a link suggests that we may be able to better predict which patients may be at risk and potentially prevent or treat cerebral vasospasm after aSAH with antiviral medicines.

STAR: Stroke Thrombectomy and Aneurysm Registry

The stroke thrombectomy and aneurysm registry (STAR), sponsored by Medical University of South Carolina, is a multicenter initiative including centers across the U.S. and the globe to track patient outcomes following a stroke thrombectomy or endovascular aneurysm treatment using data from real-world practice. The registry serves as a data source for answering questions relevant to patient selection, the effects of new interventions and techniques, and predictors of technical and clinical outcomes. All patients who are undergoing surgical interventions for central nervous system vascular legions will be included.

Computational Fluid Dynamics of Vasospasm

This retrospective study incorporates computational fluid dynamics (CFD), computed tomography angiograms (CTA), and Transcranial Doppler (TCD) wave forms obtained from patients presenting with subarachnoid hemorrhage (SAH) and vasospasm. CTA images taken prior to balloon angioplasty treatment of vasospasm are analyzed using computer simulations. Using this data, we hope to develop an effective model for predicting the likelihood of vasospasm and its location in SAH patients.

Detection of Peripheral Arterial Emboli using Doppler Ultrasound

This project aims to uncover the relationship between blood clots outside the brain and the occurrence of emboli in the cerebral vasculature as well as their associated risk of stroke. The occurrence of emboli in the cerebral vasculature is thought to correspond with the risk of stroke. Therefore, by performing peripheral arterial Doppler ultrasound scans on patients at risk of stroke as well as standard-of-care cerebral transcranial Doppler (TCD) ultrasound scans in adult cardioembolic stroke patients we hope to determine that the detection of emboli in the peripheral vasculature corresponds to the risk of stroke.

Prevention and Treatment of Poststroke Depression in Survivors of Hemorrhagic Stroke

With the support of the Brain Aneurysm Foundation, this randomized drug trial aims to use control, intervention, and observational groups of aneurysmal subarachnoid hemorrhage (aSAH) stroke survivors to assess for depression and quality–of–life after treatment. Enrolled patients will be randomized into either a control group, which receives a placebo medication, or an intervention group, which will receive fluoxetine, a selective serotonin reuptake inhibitor (SSRI) antidepressant. Patients will be evaluated for depression and health care-related quality of life immediately after treatment of aSAH and three more times in the span of a year after discharge.

Improving the computational modeling of coiled cerebral aneurysms through synchrotron microtomography

Our National Institute of Health (NIH) National Institute of Neurological Disorders and Stroke (NINDS) R01 funded project titled Improving the computational modeling of coiled cerebral aneurysms through synchrotron microtomography seeks to develop a clinically applicable coil modeling toolkit based on novel homogenization methods through looking at adult patients undergoing coil or stent-coil treatments of unruptured aneurysms. By creating this toolkit, we will be able to improve the accuracy of computational fluid dynamic (CFD) modeling of aneurysm coils without the use for microtomography to identify the factors associated with disease progression. Also, we wish to quantify the shortcomings of simplified porous medium approach to CFD.

Improving the computational modeling of cerebral aneurysms treated with flow-diverting stents utilizing platelet activation simulations

With support from the American Heart Association we use computer representations of actual patients’ brain blood vessels with cerebral aneurysms to simulate blood flow in and around the aneurysms before and after treatment with flow-diverting stents. We apply a special computer modeling technique that simulates thousands of individual platelets within the computer simulation of blood flow to understand how flow-diverting stents cause platelets to activate, leading to clotting within the aneurysm and eventual aneurysm healing. We also create precise 3D-printed physical models of the blood vessels and aneurysms of each patient, and pump a special blood-like fluid through these models to validate the accuracy of computer simulation. We use high-speed cameras and lasers to measure the speed of the blood flow within the aneurysm models, including measuring tiny microparticles in the fluid that act like platelets. The final result of this project will be a computer simulation technique that allows for accurate prediction of cerebral aneurysm treatment outcome.

Factors affecting the Natural History of Patients with Cranial Dural Arteriovenous Fistulae, Vascular Malformation (the Dural AV Fistula Consortium)

With this multi-site study, we intend to identify factors in patients with cranial dural arteriovenous fistula (dAVF) and vascular malformations of the brain as well as help elucidate whether certain types of fistulae have relatively poor clinical course. Data from various study sites will be pooled to help investigators perform well-powered analyses of multiple facts of dAVF pathophysiology and clinical course, identify specific patient subgroups, and optimize managements. Adult patients with dural arteriovenous fistula and vascular malformations of the brain are included.

UW Clot Bank

Despite a reduction in stroke incidence and age-standardized death rates, stroke remains the second leading cause of death and a major cause of disability worldwide. Several large-scale studies have shown that conventional risk factors predict less than one half of future cardiovascular events. Stroke prevention strategies may therefore be based on an incomplete set of biological and environmental risk factors. Using next generation sequencing technologies, we are studying the role of the microbiome in thrombi removed from cerebral arteries of stroke patients. A deeper understanding of the human host-microbiome interactions may help identify new risk factors and new avenues for treatment or prevention of ischemic stroke.

Support the SANS Center in discovering ways to understand, treat, and prevent stroke, cerebrovascular disease, and other neurological conditions.

Stroke & Applied Neuroscience Center

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Address: 325 9th Ave Box 359924
Seattle, WA 98104

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