Cerebrovascular, Stroke and Endovascular Program
Stroke is the number one cause of major disability in our country and the 4th leading cause of mortality today. The URMC Stroke, Cerebrovascular and Endovascular program aims to provide patients with the most comprehensive stroke care possible to ensure that they don’t become just another statistic. We understand not just the physical disability from stroke but also the economic and psychosocial burden on our community. Our diligent team at the Stroke, Cerebrovascular & Endovascular program at URMC has successfully achieved the highest rates of acute intervention and secondary stroke prevention possible for stroke in the region.
Why Choose URMC Neurosurgery?
The Stroke, Cerebrovascular and Endovascular program at URMC is the area’s only world-class program for treatment and prevention of stroke.
Our nationally recognized and highly trained team is truly one of a kind in the region and cares for all types of stroke & cerebrovascular diseases including:
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Aneurysm
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Sub-arachnoid hemorrhage
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Intracerebral hemorrhage
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Ischemic Stroke
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Vascular malformations
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Vertebro-basilar insufficiency
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Carotid Stenosis
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Intracranial stenosis
URMC has a state-of-the-art Endovascular stroke suite that enables our team to provide you with the most advanced interventions for stroke and cerebrovascular diseases.
URMC’s stroke protocol incorporates and extended panel of blood tests and the most innovative imaging studies including multi-modal CT scanning – new technologies that enable us to expand the time window to stop the devastating effects of stroke to 8 hours and beyond.
Our team uses a revolutionary procedure “endovascular thrombectomy” in addition to routine medical therapy to reach reach clots in the brain directly and gently remove them, restoring blood flow and dramatically reducing effects of stroke.
The URMC Stroke, Cerebrovascular and Endovascular program combines established methods with the latest medical and surgical techniques like carotid and intracranial stents to help prevent strokes in patients most at risk for having one.
Our Team
A state of the art Endovascular Stroke suite and our multidisciplinary team of neurosurgeons provide the most advanced care in the region.
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Babak S. Jahromi, M.D. Ph.D. Dr. Jahromi is the director of the Endovascular Stroke Program, and an Assistant Professor of Neurosurgery and Imaging Sciences. Dr. Jahromi holds a double fellowship in endovascular and cerebrovascular surgery. He has received the highest awards for neurological research in Canada, from the University of Toronto, the Royal College of Physicians & Surgeons of Canada, and the Canadian Neurological Society.
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Robert Replogle M.D. Dr. Robert E. Replogle serves as a URMC Assistant Professor of Neurosurgery and Imaging Sciences. Dr. Replogle completed a combined fellowship in neuroendovascular and operative cerebrovascular surgery at the University of Texas Southwestern and served on staff at that
institution. Dr. Replogle is also very active in the field of minimally invasive spine surgery, pioneering a numerous techniques, and has been active in teaching minimally invasive spine courses at both the national and international level.
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Cindy Zink, PA
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Kim Yirinec, RN, NP, MS
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Conditions We Treat
Below is a listing of the conditions treated by the Stroke and Endovascular Therapy Center. Please contact us, or click on a condition to read more about the condition in a new window.
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Treatments
Aneurysm Clipping
An aneurysm, is a bulging or ballooning out of a part of blood vessel wall in the brain, due to a weak point in the wall. As it enlarges the wall becomes thinner and eventually risks of ruptures causing bleeding into the brain increase. Under this surgical procedure, an opening is made into the skull, the affected blood vessel isolated, and a clip is placed across the base of the bulged portion (aneurysm) to block of blood supply. At the University of Rochester Medical Center, this aneurysm surgery can also be performed in an emergent scenario, where the aneurysm has already bled into the brain. Learn more about Aneurysm Clipping at URMC.
Aneurysm Coiling and Stenting
Endovascular Coiling is a minimally invasive procedure that involves placing coils inside the aneurysm through a catheter threaded via an artery in the groin/arm, so that blood can no longer flow into the aneurysm preventing rupture or further bleeding.
Endovascular Stenting involves diverting blood flow away from the site of the aneurysm to prevent rupture in the future, or stop bleeding. This procedure is especially useful in an emergency, wherein it is too dangerous to reach the aneurysm for clipping via open surgery.
Arterio-Venous Malformation Surgery and Embolization
Arterio-venous malformation or AVMs are abnormal connections in the vessels of the brain that directly divert blood from the arteries to the veins. They occur in less than 1% of the population, but it is unknown why they occur. They may result in bleeding in the brain, seizures, headache or difficulty with movement, speech and vision.
Therapy for AVM depends on its location, size, and the symptoms it map be causing. Surgical removal of AVM is recommended if it is accessible.
Placing a small catheter inside the blood vessels and blocking off blood supply to the AVM with variety of materials can also be used to treat part/all of the AVM - a procedure called Embolization.
Carotid Angioplasty/Stenting
A therapeutic measure offered to patients with Carotid Stenosis/Occlusion whohave high medical/surgical risks, recurrent stenosis after Endarterectomy orradiation induced carotid stenosis.
In this endovascular treatment for carotid stenosis, a catheter is threaded up to thesite of the diseased artery, a tiny balloon is inflated at the end of the catheter toopen the narrowed area and a metal stent is inserted to keep the artery fromnarrowing.
Cerebrovascular Angioplasty-Endartectomy and Bypass
This procesure is similar to the ones used by cardiologists when patients have a heart attack. This advanced procedure is often used adjunctively with endovascular thrombectomy or thrombolysis. A catheter is advanced to the site of blood vessel blockade in the brain from the groin/arm. Any stenosing deposits of cholesterol/calcium are removed. If needed, stents are introduced to support the vessels and prevent re-stenosis/occlussion. Sometime vessels that are not amenable to such therapy are bypassed by creating new connections between the normal vasculature in the brain, ensuring adequate blood supply to the brain tissue at risk.
Endovascular Thrombectomy
Endovascular thrombectomy is an innovative strategy to open blood vessels blocked with clots in the brain during a stroke, by using a mechanical device introduced via catheter from the groin under radiologic visual control. The technique is especially valuable in patients with a large vessel occlusion, including those with contraindications to thombolysis.
Intra-Arterial Thrombolysis
Intra-arterial thrombolysis offers benefit in cases with persisten obstruction (despite intra-venous thrombolysis - approximately 32-60%), patients arriving beyond the 3 hour time window for IV therapy. It also reduces hemorrhagic complications while allowing for precise imaging of anatomy, pathology and collateral pattern in the brain tissue.
Recent clinical trials have shown efficacy of almost 76% with IA Thrombolysis in stroke patients. Under this technique a catheter is advanced to the site of the block under radiological visual control, and the clot busting drugs are introduced at the site of the block, offering high concentration of the required medicine at the site og the bloackage.
Research
Research in the Center for Stroke and Endovascular Therapy focuses around gaining insight into the possible use of multi-modal CT scanning for predicting stroke outcomes and around the health services perspective on current practice for stroke treatment and its prevention in the United States. Some of the projects at the center include:
Cost Effectiveness of multimodal CT for evaluating Acute Stroke
Multimodal CT, including non-contrast CT (NCCT), CT with contrast, CT angiography (CTA), and perfusion CT (CTP), is increasingly used in acute stroke patients to identify candidates for endovascular therapy. Our goal in this study is to explore the cost-effectiveness of multimodal CT as a diagnostic test. Our findings so far indicate that Multimodal CT appears to be a cost-saving screening tool over the short term.
We are in the process of collecting additional data regarding clinical outcomes following multimodal CT-guided intra-arterial treatment to adjudge the long-term cost effectiveness of this modality. Learn more.
Utility of Carotid Artery Stenting in Asymptomatic Carotid Stenosis
This research is focused on analyzing outcomes of patients undergoing Carotid Artery Stenting in a representative sample of countrywide inpatients. Our initial research has shown, that Carotid Artery Stenting as practiced currently in the country, is independently associated with increased in-hospital stroke/death in patients ≥ 80 years of age.
We are in the process of analyzing outcomes in other age groups. This research highlights the importance of auditing procedures nationally to formulate definitive guidelines for the use of invasive procedures. Learn more.
Perfusion CT scanning in Acute Ischemic Stroke
This research study is focused on analyzing variables availed by doing perfusion CT scanning in patients of acute ischemic stroke and their association with functional outcomes in patients. This research also looks at using the variables to predict important complications of therapy in stroke like Hemorrhagic Transformation and re-current stroke. This research will also look at the feasibility of introducing Perfusion CT scanning in regular Acute Ischemic Stroke screening protocols.
New therapies for treating Vasospasm after Sub Arachnoid Hemorrhage
Sub-arachnoid hemorrhage (SAH) is a form of stroke that comprises 1-7% of patients. It can lead to death or severe disability even when recognized and treated at an early stage. More than 50% of patients die after suffering an SAH. The most common complication of SAH is the vasospasm that follows it. This research is looking at new invasive and non-invasive modalities to address this common complication to improve outcomes in patients.
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