Interdisciplinary collaborations and pioneering critical care contribute to remarkable clinical outcomes for high-acuity patients.
As a Level I trauma center and home to the robust Smidt Heart Institute and the world-class Comprehensive Transplant Center, Cedars-Sinai and its Comprehensive Stroke Center treat the most complex and severely ill patients. Despite its high-acuity population, Cedars-Sinai consistently achieves one of the lowest stroke mortality rates in the country. These outcomes are a testament, in part, to the highly innovative Neurocritical Care Unit, which constantly monitors and assesses data to improve upon the preservation and recovery of neurological function.
Yet, neurovascular disease remains a leading cause of long-term disability, and Cedars-Sinai investigators are looking to expand equitable treatment options. Ongoing studies are examining the role of eicosanoids in stroke and neurovascular outcomes. Investigators are analyzing blood samples from a diverse group of stroke patients to determine whether eicosanoid levels correlate with cognitive outcomes. As part of a grant from the National Institutes of Health, researchers are analyzing longitudinal data to identify patterns of stroke risk associated with baseline eicosanoid levels.
"Our collaborations enable community hospitals to perform advanced diagnostics and lifesaving treatments for patients as quickly as possible, while offering advanced subspecialty care." —Shlee Song, MD
Cedars-Sinai is also pioneering the use of indirect revascularization to treat intracranial atherosclerotic disease (ICAD), a leading cause of stroke with notoriously poor prognosis. The results of a Phase II study published in the peer-reviewed International Journal of Stroke showed that among ICAD patients who failed medical management, those who underwent indirect revascularization experienced a reduction in stroke rates at two years by more than half, from 21.9% to 9.6%. Investigators continue to enroll patients in a prospective registry to evaluate the technique’s efficacy.
Intracranial Stenting Prevents Stroke and Restores Function
Cornelius Albert is an athletic professional—a lifelong runner who runs a court-filing service. Last year, the 76-year-old Los Angeles resident scheduled an appointment with his cardiologist to address dizziness, weakness and imbalance he’d been experiencing for two months. During the visit, he suffered a transient ischemic attack.
A magnetic resonance angiogram revealed an 85% cholesterol plaque blockage in an artery to his brain, and doctors diagnosed Albert with intracranial atherosclerotic disease (ICAD).
Three days later, Albert underwent an intracranial stenting procedure performed by Michael Alexander, MD, vice chair of Neurosurgery and director of the Neurovascular Center and Endovascular Neurosurgery at Cedars-Sinai. Albert’s symptoms have since resolved, and angiograms demonstrate a near-complete improvement.
Two multicenter studies led by Alexander, published in 2019 and 2021, concluded that intracranial stenting and medical therapy safely and successfully reduced the incidence of future strokes in patients like Albert. In 2021, after publication of the landmark trials, the American Stroke Association began recommending the procedure for patients with severe ICAD who fail medical therapy.
“Four or five years ago, standard treatment for ICAD patients was cholesterol-lowering and anti-clotting medications,” said Alexander. “Mr. Albert was already taking those medications, and they weren’t helping. With a minimally invasive procedure to place a stent and keep his arteries open, we relieved his symptoms and likely saved his life.”
Albert’s symptoms had been so dangerous that he’d stopped driving. After the stent procedure, he recovered quickly and regained his independence.
“It felt like a miracle,” Albert said. “Those attacks were really scary, and having this procedure was a blessing.”
Michael Alexander, MD Vice Chair, Neurosurgery Director, Neurovascular Center and Endovascular Neurosurgery Professor of Neurosurgery
Shlee Song, MD Director, Comprehensive Stroke Center Director, Telestroke Program Vice Chair, Neurology System Integration Professor of Neurology
Nestor Gonzalez, MD Director, Neurovascular Laboratory Professor of Neurosurgery
Alexis Simpkins, MD, PhD, MSCR Director, Vascular Neurology Research and the SkRIPT Research Program Associate Professor of Neurology