MUSC’S MEDICAL MAGAZINE // SPRING 2018 Redefining Neuroscience Upcoming CME Conferences MUSC Health The following conferences, sponsored by the Medical Video Center Medical University of South Carolina, will be MUSChealth.org/medical-video held in Charleston unless otherwise noted. Visit www.musc.edu/cme for a complete list A sampling of current videos: of CME conferences. The COMPASS Trial MUSC Health neurointerventional radiologist Aquilla S. Turk, D.O., discusses preliminary April 14, 2018 Spine Conference 2018 – Controversies in Spine Care findings from the COMPASS trial, a head- Kiawah Island Golf Resort to-head comparison of the direct-aspiration, first-pass technique, pioneered at MUSC April 17-21, 2018 MUSC Pathology Multi-Specialty Symposium Health, and stent retrievers for thrombectomy. Kiawah Island Golf Resort What’s New in the 2018 AHA/ASA Guidelines for Acute Ischemic Stroke? April 20-22, 2018 South Carolina Rheumatism Society 2018 Annual Meeting Edward C. Jauch, M.D., interim chair of the Hyatt Place Charleston Department of Emergency Medicine and one of the authors of the recent guidelines, discusses April 26-28, 2018 47th Postgraduate Course in Surgery updates in recommendations for stroke care. Hyatt Place Charleston New Techniques for Treating Secondary Effects of Intracerebral Hemorrhage April 28, 2018 5th Annual Lowcountry Sickle Cell Disease Symposium MUSC Health neurosurgeon Alejandro M. MUSC Drug Discovery Building Auditorium Spiotta, M.D., discusses minimally invasive surgical techniques for evacuation of hematoma May 24-26, 2018 2018 Evidence-Based Drug Therapy Update in patients with intracerebral hemorrhage. Crowne Plaza Hotel, North Charleston Deep Brain Stimulation MUSC Health neurosurgeon Istvan Takacs, June 1-2, 2018 18th Annual Charleston Magnolia Conference M.D., discusses how deep brain stimulation Hyatt House Charleston controls symptoms and improves quality of life in patients with Parkinson’s disease, essential June 6-9, 2018 42nd Annual Cardiology Update tremor and dystonia. The Francis Marion Hotel Laser Ablation for the Treatment of June 11-16, 2018 Family Medicine Update Temporal Lobe Epilepsy MUSC Health neurosurgeon William A. Kiawah Island Golf Resort Vandergrift, M.D., discusses an alternative to traditional surgery for patients with medication- July 13-15, 2018 The Charleston Course: 8th Annual refractory temporal lobe epilepsy. Otolaryngology Literature Update Kiawah Island Golf Resort Pineal Gland Surgery Sunil J. Patel, M.D., chair of the Department of Neurosurgery, explains that some pineal cysts are in fact pineocytomas and that their removal provides relief from a novel constellation of symptoms. PROGRESSNOTES // SPRING ���� INSIDE MUSC’S MEDICAL MAGAZINE // SPRING 2018 16 22 Retuning the Brain Restoring Poetry Minimally invasive thera- to Motion pies provide good seizure While not a cure, deep brain control for patients with stimulation can alleviate some of medication-refractory focal the most debilitating symptoms epilepsy of advanced Parkinson’s disease, essential tremor and dystonia to 2 10 In Short A Bold Experiment improvequality of life The Zucker Institute for Aspiration as good as stent Applied Neurosciences retrievers for large clots brings together the Treatment to reverse compli- worlds of engineering and cations from botox therapy medicine to speed the 26 translation of innovative Welcome Space travel and the brain technology into the clinic MUSC Health Welcomes Dr. Eugene Hong as New Chief A new cell line for juvenile Physician Executive pilocytic astrocytoma 18 Pericytes and brain plasticity Language Lost New Physicians 14 and Found Pineal Cysts: New language discoveries Worth a Second inform therapies for aphasia Look after stroke 8 MUSC Health neurosur- New Stroke geon identifies a novel Guidelines constellation of symptoms An interview with Dr. that resolve upon excision Edward C. Jauch, one of of pineal lesions the guidelines’ authors On the cover: Stylized brain image depicting the pineal gland as a vesti- gial third eye. Illustration by Emma Vought MUSC’S MEDICAL MAGAZINE 1 IN SHORT Dr. Aquilla Turk (front left) in the angiography suite CLINICAL RESEARCH fellow neurointerventional radiologist M. Imran Chaudry, M.D., and neuro- surgeons Alejandro M. Spiotta, M.D., Aspiration as Good as and Raymond D. Turner, M.D., uses a large-diameter aspiration catheter (ACE68™, Stent Retrievers for Penumbra) to remove the clot in its entirety. Preliminary findings from the trial Large-Vessel Clots were presented at the International Stroke Conference in Los Angeles in January 2018. An interview with a principal investigator They showed that comparable functional for the COMPASS trial outcomes and revascularization rates were attained by ADAPT and stent retrievers in stroke patients with large-vessel clots. Neurointerventional radiologist Aquilla S. Sinai and Adnan Siddiqui, M.D., Ph.D., of the ADAPT was also shown to reduce procedure Turk, D.O., is one of the principal investiga- Jacobs School of Medicine and Biomedical times and to be more cost effective. The tors (PIs) for the COMPASS trial, a head- Sciences at the University at Buffalo. full results of the COMPASS trial, including to-head comparison of the direct-aspiration, Stent retrievers, the current standard the economic data, will be presented at first-pass technique (ADAPT), pioneered of care for mechanical thrombectomy in the annual Society of Neurointerventional at MUSC Health, and stent retrievers for patients with acute ischemic stroke, are Surgery meeting in San Francisco in July. thrombectomy of large-vessel clots. The cage-like devices that are used to “engage” Progressnotes sat down with Turk to learn other PIs for the trial are J. Mocco M.D., MS, and then remove the clot. ADAPT, more about ADAPT and the COMPASS of the Icahn School of Medicine at Mount developed at MUSC Health by Turk, trial results. 2 PROGRESSNOTES // SPRING ���� IN SHORT PN: How is aspiration used to remove angiographically. From what we’ve seen COLLABORATION large-vessel clots? so far, our results are almost identical. Our Aspiration is something that we happened primary end point was functional outcome The Charleston upon back in 2013. The seminal case for — whether the patients were able to be func- Summit us was one where we actually did a throm- tionally independent (defined as a modified bectomy using a large catheter with a stent Rankin score of 0-2). In the ADAPT arm, Since 2011, MUSC has hosted The retriever through it. We pulled the stent about 51 percent of patients had a modified Charleston Summit of Advanced Ideas retriever out, and there was nothing on it, but Rankin score of 0 to 2, whereas, in the stent and New Technology, an influential the catheter was clogged. So we pulled the retriever group, 49 percent of patients were meeting where key opinion leaders in catheter out, thinking that we would have to functionally independent. So, there was not a stroke surgery can discuss future direc- go back up and do it again, and the large clot significant difference between the two. tions in the field in a safe forum. was embedded in the end of the catheter. Attendees include the leaders of So a light bulb went off for us. That’s what PN: What are the advantages of ADAPT? major national and international sci- started us trying to use aspiration alone. ADAPT is very simple to do. Whether entific organizations and endovascular Before that, the company (Penumbra) neurointerventionalists, cardiologists, neurosurgeons, interventional radiolo- sold the catheters, but they had these little peripheral interventionists or vascular gists and interventional neurologists wires with stoppers on the end that they surgeons — we all drive catheters over wires from top-flight health care institutions, used to break up the clot and then clear the through blood vessels. And if the goal is just such as Mayo Clinic, Cleveland Clinic end of the catheter. But that just fragmented to take a catheter and drive it to the level of and Johns Hopkins University. There is a the clot and sent more of it downstream. occlusion, and that’s all you have to do to good mix of established authorities and And we’d have to work our way through the get it open, that’s about as easy as it gets. So young leaders in the field. Attendees sign vascular tree to open one-sized vessel, and that also implies speed and safety because a non-disclosure agreement to ensure then go to the next smaller, and the next you’re not having to deploy multiple devices. positive, open dialogue without fear of smaller. With aspiration alone, we were able And it implies lower costs. It’s just one of compromising intellectual property. to pull the entire clot out without breaking it those common sense approaches across Unlike typical scientific meetings, no up the majority of the time. the board. If it’s that simple, it should be the industry representatives are present, fur- So it gave us an idea — if we can just take easiest way to go. ther encouraging open, frank dialogue. a catheter, drive it to the clot, turn on suction So for me the COMPASS trial was A popular topic of the summit is and then pull the clot out, or have it get sucked just the final, validating study that gives us developing new scientific trials. Trial out through the catheter, that would be much Level 1 evidence that, in a head-to-head trial ideas generated at this meeting have simpler and really a home-run way to go. against stent retrievers, aspiration is at least garnered approximately $20 million in as good. And certainly, to me, aspiration research support, including funding for PN: Can you describe the preliminary is the way to start doing a thrombectomy the COMPASS (NCT02466893), POSITIVE findings of the COMPASS trial? procedure. I say that because you simply (NCT01852201) and LARGE trials. The COMPASS trial randomized patients drive the catheter to the face of the clot.