EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable. Add/delete rows as necessary.)
INSTITUTION AND LOCATION
FIELD OF STUDY
Marquette University, Milwaukee, WI
Universidad Central Del Caribe, PR
The George Washington Medical Center, DC
The George Washington Medical Center, DC
University of Texas Medical Center, Houston
Neurocritical Care Fellowship
NOTE: The Biographical Sketch may not exceed five pages. Follow the formats and instructions below.
A. Personal Statement
My training has been in the care of patients with cerebrovascular diseases and neurocritical care illnesses with special emphasis on patient’s with strokes. I have been involved in the clinical research of stroke patients since very early in my career. My daily practice in an academic institution continues primarily in the care of patients that suffer strokes. I have participated in the past in clinical trials aiming to translate basic science and clinical research into applicable treatment interventions as well as in the applications of treatment interventions to the care of patients with stroke. My participation in these trials has been both as co-investigator as well as primary investigator in national and international trials.
B. Positions and Honors
See above under education and training as well as follows
1998-07 - Assistant Professor, UT Southwestern, Department of Neurology
1999-Present – UTSW Neurosonology Laboratory Director of Neurology section followed by full Director
2005-2011 – Service Chief – Parkland Memorial Hospital Neurology
2005-2009 – Medical Director, Neurology Residency Clinic Parkland Memorial Hospital
2005-2015 – Medical Director, Stroke Service Parkland Memorial Hospital
2007- 2015 - Associate Professor, UT Southwestern, Department of Neurology & Neurotherapeutics
2007-Present – Chief, Cerebrovascular Diseases & Stroke Departmental Section
2007-2015 – Program Director, UT Southwestern Vascular Neurology Fellowship
2012–2015 – Medical Director, Neurosciences Services UTSW University Hospitals
2015-Present – Professor, UT Southwestern, Department of Neurology & Neurotherapeutics
2016-Present – Medical Director, Stroke Program UTSW University Hospitals
2005 – Resident Teaching Award “The Trephine Cranium” For Excellence in Teaching
2006 – Gold Level Service PACT Employee Recognition Program
2007 – Stroke Volunteer of the Year Award, Dallas/FT Worth and East Texas South Central Aff. AHA
C. Contribution to Science
Large vessel atherosclerotic vessel disease as manifested in both intracranial arterial stenosis as well as extracranial arterial occlusion are important cause of stroke and transient ischemic attacks. Learning medical and procedural/surgical interventions that can help reduce the risk of stroke or that are felt to be the best first steps to take in the care of these patients has been an important approach needing to be clarified. The Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis trial (SAMMPRIS) showed that aggressive medical management of patients with intracranial arterial stenosis was superior to percutaneous transluminal angioplasty and stenting. This trial has established the use of aggressive medical, dietary and exercise interventions in this patient group as important initial treatment as opposed to starting with procedural intervention which often has been thought to be a first step for other similar disease process but in a different arterial location (as for example CEA and CAS in the extracranial carotid arteries). Extracranial carotid artery disease with stenosis has been well researched. Extracranial carotid artery occlusion had a study done in the 1980s (EC-IC bypass study) which did not find benefit in bypass surgical interventions. More recently studies using PET technology seemed to find potential candidates for further investigation since it discovered patient’s at higher risk for stroke (with abnormal PET oxygen extraction fraction). In the Carotid Occlusion Surgery Study (COSS) patients with carotid occlusion with transient ischemic attack or ischemic stroke patients where randomized to bypass vs medical therapy. In this trial STA-MCA bypass intervention did not show benefit over medical therapy. Overall, these trials have helped in the better understanding of the management of patients with large vessel disease. My participation in this trial was primarily in the recruitment and management of the local patients that participated in this trial.
1. Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, Janis LS, Lutsept HL,
Barnwell SL, Waters MF, Hoh BL, Hourihane JM, Levy EI, Alexandrov AV, Harrigan MR, Chiu
D, Klucznik RP, Clark JM, McDougall CG, Johnson MD, Pride GL Jr, Torbey MT, Zaidat
OO,Rumboldt Z, Cloft HJ; SAMMPRIS Trial Investigators. Stenting versus aggressive medical therapy for intracranial arterial stenosis. NEJM. 2011; Sep 15; 365 (11)993-1003. Epub 2011 Sep 7.
2. Powers, WJ et al…for the COSS Investigators. Extracranial-Intracranial Bypass Surgery for
Stroke Prevention in Hemodynamic Cerebral Ischemia: The Carotid Occlusion Surgery Study
Randomized Trial. JAMA. 2011; 306; 18: 1983-1992.
3. Fiorella, D, Derdeyn, CP, Lynn, LJ, Barnwell SL, Hoh, BL, Levy EI, Harrigan, MR, Klucznik, RP,
McDougall, CG, Pride GL Jr, Zaidat, OO, Lutsep, HL, Waters, MF,Hourihane, JM, Alexandrov,
AV, Chiu, David, Clark, JM, Johnson MD, Torbey, MT, Rumboldt, Z, Cloft HJ, Turan, TN, Lane,
BF, Janis, LS, Chimowitz, MI for the SAMMPRIS Investigators Detailed Analysis of
Periprocedural Strokes in Patients Undergoing intracranial Stenting in Stenting and Aggressive
Medical management for Preventing Recurrent Stroke in Intracranial Stenosis. Stroke. 2012;
Small Subcortical brain infarcts (“small vessel disease) also known as lacunar strokes is a common cause of stroke (up to 25% of Ischemic strokes). This type of stroke not only contributes in disability but also cumulatively in conditions like vascular dementia. The SPS3 trial has helped to learn more regarding the best antiplatelet potential approach in that it found that monotherapy was as effective as dual antiplatelet with less increase in hemorrhagic complications. In addition this trial supports that intense blood pressure treatment in patients with lacunar strokes likely benefit of intense blood pressure treatment. My participation in this trial was in the recruitment and management of the local patients that participated in this trial.
1. The SPS3 Investigators. Effects of Clopidogrel Added to Aspirin in Patients with Recent
lacunar Stroke. NEJM 2012; 367:817-25.
2. The SPS3 Study Group. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomized trial. Lancet 2013; 507-515.
Cerebral Venous Sinus thrombosis is an uncommon cause of stroke but it can have a significant risk of poor outcomes. Medical therapy includes heparin use but in some cases specially when started late this medical intervention has bad outcomes. Current neurointerventional therapies have been intrasinus (intravenous) interventions versus mechanical thrombectomy (clot removal). Learning more about which interventions are potential better type’s approaches has been an important need in the management of this condition. This research studies have helped in the better understanding of the treatment of patients with cerebral venous thrombosis. The use of mechanical thrombectomy is note to be particularly promising neurointerventional. My participation in this studies have been in the article revision and patient contribution.
1. Siddiqui FM, Banerjee C, Zuurbier SM, Hao Q, Ahn C, Pride GL, Wasay M, Majoie CB,
Liebeskind D, Johnson M, Sam J. Mechanical Thrombectomy versus Intrasinus Thrombolysis
for Cerebral Venous Sinus Thrombosis: A Non-Randomized Comparison. Interv Neuradiol 2014
June 30; 20 (3): 336-44.
2. Siddiqui FM, Dandapat S, Banerjee C, Zuurbier S, Johnson M, Stam J, Coutinho J. Mechanical Thrombectomy in Cerebral Venous Thrombosis: Systematic Review of 185 Cases
Having a transient ischemic attack and an ischemic stroke is known to be associated with having a higher risk for cardiovascular events. Some of this patients have also been found to have insulin resistance. Finding insulin resistance in this group provides the opportunity of treating with current agents like pioglitazone. Participating and completing the IRIS trial has contributed in the better understanding of insulin resistance in patients with TIA or stroke. It also has helped in finding pioglitazone as one potential treatment intervention to reduce risk of stroke, myocardial infarction, and diabetes in spite of noted increased risk of fractures, edema and weight gain. My participation in this study was in the recruitment and management of the local patients that participated in this trial.
- Kernanet al…for the IRIS Trial Investigators. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack
D. Research Support
1. # NCT00091949; NIH-NINDS/Yale; Insulin Resistance Intervention after Stroke (IRIS - Completed 2016)
2. #NCT00576693; NIH-NINDS/Medical Univ. South Carolina; Stenting and Aggressive Medical management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS - Completed 2013)
3. #NCT00991029; NETT/MUSC/EMMES Corp; Platelet-Oriented Inhibition in New TIA and Minor
Ischemic Stroke Trial (POINT - Ongoing)
4. #NCT02121028; University of Miami; Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD - Ongoing)
5. #NCT02313909; Bayer; Rivaroxaban versus Aspirin in Secondary Prevention of Stroke and Prevention of Systemic Embolism in Patients with Recent Embolic Stroke of Undetermined Sources (ESUS) (NAVIGATE ESUS - Ongoing)
6. #NCT02700945; Medtronic; Rate of Atrial Fibrillation through 12 months in Patients with Recent Ischemic Stroke of Presumed Known Origin (Stroke AF - Ongoing)
My responsibilities in the above clinical trials as principal investigator in my institution include recruitment and proper consent of subjects in the studies, supervision of the research team, continual overseen of the conduction of the trial, and making sure that the trials are compliant with all national and local policies and procedures.
No financial relationships have been disclosed.