Improving Patient Outcomes
Led by Surgical Director Arthur L. Day, MD, and Medical Director Steven K. Feske, MD, the Stroke and Cerebrovascular Center applies innovative, multimodality treatment designed to address each patient’s specific needs and improve the outcome of patients with stroke and cerebrovascular disease.
Center specialists – including neurologists, neurosurgeons, neuro-interventionalists, vascular surgeons, and emergency medicine physicians – deliver rapid, accurate, and advanced assessment and treatment for patients with stroke and cerebrovascular disease, including:
Specialized Emergency Care for Stroke Patients
Rapid response and early intervention are considered of paramount importance for patients with acute stroke and other critical neurological conditions. The Brigham and Women’s Hospital Emergency Cardiac Neuro Unit (ECNU) includes:
A dedicated five-bed unit designed to expedite evaluation and treatment of severe, life-threatening neurological and cardiac emergencies;
Specialized emergency care staff who facilitate triage and immediate access to the Stroke and Cerebrovascular Center using a streamlined series of rapid assessments.
Advanced Stroke Diagnosis
The Stroke and Cerebrovascular Center’s multidisciplinary team evaluates and treats patients using advanced diagnostic tools, including:
16-channel CT scanner provides an image of the brain and blood vessels in only eight seconds and is used to triage patients, rapidly target brain tissue at risk, and identify and initiate the best therapy for the patient;
Diffusion-perfusion MRI detects changes at the cellular level and also helps to pinpoint areas of irreversible cell death, as well as the mechanism of the stroke;
SPECT scanning is useful in detecting changes during the acute phase of a stroke, as well as advanced surgical planning.
Innovative Stroke and Cerebrovascular Treatment
Using highly-detailed information derived from the Stroke and Cerebrovascular Center’s advanced diagnostic capabilities, the multidisciplinary team of specialists in the Center works together to deliver the best treatment combination for each patient, including medical, interventional, and surgical therapies.
Medical and Endovascular Therapies
Center specialists often use intravenous and intra-arterial thrombolytic agents in the treatment of stroke. Medical treatment for stroke at the Center includes:
Intravenous thrombolysis with tPA;
Intra-arterial thrombolysis with tPA and mechanical thrombolysis and clot retrieval;
Identification and treatment of the underlying cause and associated risk factors as secondary prevention.
Neurosurgical Procedures
Surgical Director Arthur L. Day, MD, and neurosurgeons Robert M. Friedlander, MD, Kai U. Frerichs, MD, and Dong H. Kim, MD, perform innovative neurosurgical procedures, including:
Simple and complex intracranial bypass procedures;
Craniectomy and hemispheric decompression for stroke patients with a large area of brain affected;
Carotid endarterectomy, skull base approaches to aneurysm clipping, and AVM resection to prevent stroke or stroke recurrence while minimizing disturbance of normal brain tissue;
Stereotactic radiosurgery to treat AVMs inaccessible by other means;
Endovascular surgery to treat intracranial aneurysms, AVMs, and extracranial and intracranial obstructions (angioplasty, stenting).
Intraoperative arteriography is used during many surgical procedures to confirm success before closure.
Neuro-interventional Procedures
The state-of-the-art interventional neuroradiology suite at Brigham and Women’s Hospital includes several procedure rooms within the OR complex dedicated to neuro-interventional procedures. The suite’s novel, flat plate angiographic scanner provides lower radiation exposure and highquality, three-dimensional images that guide interventionalists Kai U. Frerichs, MD, and Sean P. Cullen, MD, enabling them to perform advanced therapeutic procedures more easily and safely. These procedures include:
Urgent revascularization of acute arterial occlusions;
Angioplasty and stenting of occlusive vascular lesions in the carotid arteries and intracranial blood vessels and coil embolization of cerebral aneurysms;
Coiling of intracranial aneurysms, including a new detachable coil that encourages scar tissue formation during aneurysm healing;
Microcatheter injection to fill malformations and decrease the risk of dangerous bleeding in patients with intracranial vascular malformations, including AVMs.
Neuroscience ICU
Medical Director Galen V. Henderson, MD, and Surgical Director Dong H. Kim, MD, lead the dedicated, 10-bed Neuroscience Intensive Care Unit at Brigham and Women’s Hospital. The Neuroscience ICU includes:
Neurologists, neurosurgeons, and other specialists working as a team to provide care for patients with acute neurological conditions, such as ischemic stroke, subarachnoid and intracerebral hemorrhage, Guillain-Barré syndrome, myasthenia gravis, status epilepticus, and encephalitis;
State-of-the-art equipment, including onsite CT imaging and intracranial monitoring;
New intracranial tissue oxygenation monitors and microdialysis catheters to measure real-time cerebral biochemistry.
Pioneering Stroke and Cerebrovascular Research
Extensive research efforts at the Stroke and Cerebrovascular Center at Brigham and Women’s Hospital include many NIH-funded studies designed to lead to new therapies for stroke and cerebrovascular disease.
Researchers at the Center are examining:
Mechanisms of neuroapoptosis, or programmed cell death, in the evolution of stroke;
Use of neuroprotective agents to minimize cell death in stroke, traumatic brain injury, and cerebrovascular disease;
Markers and mechanisms of injury in stroke;
Micro- and cerebrovascular pathophysiology, molecular pathology, and therapeutic ramification of stroke;
Endovascular devices, such as the Concentric® MERCI Retrieval System;
Transcranial Doppler ultrasound in the study of hemodynamic pathophysiology;
Genetic basis for cerebrovascular disorders, including aneurysms.
Ongoing clinical trials include the development of new methods to lyse intracranial clots to reestablish blood flow faster and more extensively than can be achieved with medications alone. The Division of Vascular Surgery at Brigham and Women’s Hospital is also participating in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) to compare carotid endarterectomy to angioplasty and carotid stenting in patients with carotid artery stenosis.
More about the Stroke and Cerebrovascular Center
The Stroke and Cerebrovascular Center is part of the Institute for the Neurosciences at Brigham and Women’s Hospital. Founded by the departments of Neurology, Neurosurgery, Psychiatry, and Radiology, the Institute for the Neurosciences is dedicated to the scientific understanding and treatment of all nervous system conditions. These include brain and spine tumors, cerebrovascular disorders, epilepsy, movement disorders, neurodegenerative diseases, neuro-immunology, neuromuscular diseases, neuro-ophthalmology, neuroscience intensive care, pain, psychiatric disorders, and spine disorders. More than 300 faculty, staff, and trainees collaborate in delivering innovative, compassionate, and patient-centered care.
A Premier Teaching Institution
A teaching affiliate of Harvard Medical School, all Brigham and Women’s Hospital physicians are also faculty members of Harvard Medical School. Brigham and Women’s Hospital experts have provided training to many of the nation’s leading neurosurgeons, neurologists, psychiatrists, neuro-oncologists, and other specialists in their fields.
The Partners Neurology Program, an approved program by the Accreditation Council of Graduate Medical Education, is a collaborative training program enabling residents to enjoy rotations between Brigham and Women’s Hospital and Massachusetts General Hospital. This highly competitive and selective program receives many applications each year for its 14 residency spots.
Brigham and Women’s Hospital also offers neurology, neurosurgery, endovascular surgery, and psychiatry fellowship programs in cerebrovascular disease, neuro-oncology, clinical neurophysiology, epilepsy, neuromuscular diseases, neurologic intensive care, multiple sclerosis, behavioral neurology, medical psychiatry, neuropsychiatry, and psycho-oncology.
Multidisciplinary Team of Stroke and Cerebrovascular Disease Experts
ARTHUR L. DAY, MD, Surgical Director, Stroke and Cerebrovascular Center, is a nationally-renowned neurosurgeon specializing in advanced neurosurgical procedures for cerebrovascular diseases, including lesions often considered untreatable. Dr. Day’s research interests include neuroprotective effects of estrogens against focal and global cerebral ischemia and protection of nerve cells following intracerebral and subarachnoid hemorrhage.
STEVEN K. FESKE, MD, Medical Director, Stroke and Cerebrovascular Center, is an expert in stroke neurology and innovative medical therapy for stroke. Dr. Feske is currently collaborating in the investigation of a mechanism of cell signaling, thought to mediate inflammatory responses during stroke evolution.
KAI U. FRERICHS, MD, an endovascular neurosurgeon, uses leading multimodality approaches for cerebrovascular disease treatment, including coil embolization of cerebral aneurysms, intra-arterial interventions for clot thrombolysis and removal in acute stroke, carotid and intracranial stenting and angioplasty, and cerebral and spinal AVM. Dr. Frerichs’ research focus includes the development of novel neuroprotective strategies for stroke and neurotrauma.
ROBERT M. FRIEDLANDER, MD, an expert neurosurgeon, holds a special research interest in
mechanisms of apoptosis, or programmed cell death. Leading a team of researchers, Dr. Friedlander is investigating ways to stop or slow the progression of cell death in stroke and traumatic brain and spinal cord injuries, as well as neurodegenerative diseases.
GALEN V. HENDERSON, MD, Medical Director of the Neuroscience Intensive Care Unit at Brigham and Women’s Hospital, is currently evaluating the incidence, management, and outcome of non-aneurysmal subarachnoid hemorrhage, as well as mechanical retrieval for acute ischemic stroke.
DONG H. KIM, MD, Surgical Director of the Neuroscience Intensive Care Unit, was recently recruited to Brigham and Women’s Hospital with extensive experience in both surgical approaches and critical care management. Dr. Kim’s laboratory has recently linked aneurysm formation to a specific location in the genome, which may lead to the identification of a gene defect.
FARZANEH A. SOROND, MD, PhD, is a neurologist specializing in diagnosis and treatment of stroke and cerebrovascular disorders, including the use of transcranial Doppler ultrasound monitoring for the evaluation of hemodynamics of cerebral blood flow regulation. Dr. Sorond has conducted extensive research towards the understanding of clinical disorders and mechanisms of cerebral autoregulation (CA) as a means to develop effective therapeutic and preventive strategies for patients with impaired CA resulting from stroke or cerebrovascular disorders.
LEIGH R. HOCHBERG, MD, PhD is a neurologist with expertise in stroke and critical care neurology. His research interests include the development of brain-computer interfaces for those with severe paralysis secondary to stroke, spinal cord injury, and neuromuscular disease.
Your Connection to Brigham and Women's Hospital
If you would like to refer a patient to the Stroke and Cerebrovascular Center, please contact:
The Center’s cerebrovascular and endovascular neurosurgeons at (617) 525-7777;
The Center’s stroke neurologists at (617) 732-5656, #31382.
For 12 years in a row, Brigham and Women’s Hospital has been included on the U.S.News & World Report® Honor Roll of “America’s Best Hospitals.”
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