Research Basic Science and Clinical Research Research goals of the Stroke Center include: Expanding our understanding of the mechanisms of ischemic injury to the brain Improving acute ischemic stroke treatment Developing more effective strategies in secondary stroke prevention Identifying cost-effective diagnostic testing and treatment. Clinical stroke research includes: Active participation in clinical trials of novel treatment agents for acute stroke (Activated Protein C), endovascular interventions in acute stroke, insulin in hyperglycemic patients with intracerebral hemorrhage, and secondary prevention in patients with insulin resistance, small vessel ischemic disease or patent forament ovale. Identifying predictive factors for the use of transesophagel echocardiography in acute stroke Cost-effectiveness of carotid artery stenting vs endarterectomy Characterizing risk of stroke in patients with ventricular-assist devices Utility of telemetry in acute stroke monitoring Use of anti-platelet agents following carotid interventions Medical vs. surgical management of unruptured brain AVMs Genetic study of strokes in siblings Basic science research includes: Investigating the response of the brain to hypoxia and how it influences cell death during stroke. In particular, we are interested in the role of Hypoxia-inducible factor 1 alpha in altering cell death during hypoxia and stroke Collaborative research on putative neuroprotectants in acute ischemic stroke (Berislav Zlokovic, M.D., Ph.D.) Surgical Research Research in the UR Medicine Comprehensive Stroke Center 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. Optimal Patient Selection and Imaging for Carotid Endarterectomy This research focuses on how to best select patients who will benefit from carotid surgery or stenting to prevent future stroke, and the role of CT angiography in carotid endarterectomy. 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. Learn more. 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.