The Comprehensive Stroke Program within the Department of Neurology at Wayne State University is one of the leading stroke programs in the United States. It is currently staffed by five vascular neurologists, three faculty in the associated neurocritical care program, three interventional neurologists, one vascular neurology (stroke) fellow, and two nurse coordinators.
The Comprehensive Stroke Program continues to serve as a regional leader in clinical research seeking to identify the optimal treatment modalities for patients with acute stroke and treatment strategies for stroke prevention. Over 1000 patients with stroke are seen each year in the outpatient vascular neurology clinic and over 400 per year are seen as inpatients. The outpatient stroke clinic serves as a referral center for patients from all parts of Michigan. The acute stroke team evaluates patients at the downtown Detroit Medical Center hospitals for acute treatment with “clot-busters” or other modalities. The acute stroke team’s capabilities were essential in the designation of Detroit Receiving Hospital as a JCAHO-certified primary stroke center. Since 2007, Sinai-Grace Hospital and Huron Valley Hospital have been covered by the Acute Stroke Team via telemedicine (see below). All Detroit Medical Center adult acute bed hospitals have recently become certified Primary Stroke Centers. All Detroit Medical Center adult acute care hospitals have become certified Primary Stroke Centers. In addition our physicians also provide 24/7 acute stroke coverage via telemedicine for approximately 30 other hospitals in Michigan through the Michigan Stroke Network.
In the research area, previous and current funding has included attempts to identify African Americans at increased risk for stroke as well as efforts to improve the quality of stroke care in Michigan and nationally. A recent publication focused on identifying factors associated with misdiagnosis of stroke in young adults. We have participated in several major clinical trials which have evaluated new strategies for stroke prevention and these studies have been published in reputed journals such as the New England Journal of Medicine and Journal of the American Medical Association.
Current areas of research are investigating new “clot busters” for patients with acute stroke and investigation of new blood thinners for stroke prevention. A novel medication is also being tested to promote motor recovery from a recent stroke.
Seemant Chaturvedi, MD, Director of the Comprehensive Stroke Program, served on an American Stroke Association writing committee that published new guidelines in 2011 on prevention of first stroke (primary stroke prevention). Dr Chaturvedi also serves on the executive committee of several studies pertaining to carotid revascularization. Dr Chaturvedi is an elected member of the American Neurological Association and is a member of the Editorial Board of Neurology, the journal of the American Academy of Neurology. Dr Chaturvedi also serves on the editorial board of Stroke, official journal of the American Stroke Association.
Kumar Rajamani, MD is the WSUsite principal investigator for an NIH sponsored SmartRisk trial looking at MRI features of asymptomatic carotid plaques based on which one could determine which patients are at high risk for stroke due to carotid stenosis. Traditional thrombolytic therapy with tPA is approved for use within 3 hours. However, many stroke patients present after this window of treatment is lost. Dr Rajamani is site PI for the study (DIAS 4) investigating a newer thrombolytic medication-desmoteplase in acute stroke patients which is being administered at 3-9 hours after the stroke potentially widening the therapeutic window. Dr Rajamani is currently the Vascular Neurology Fellowship Program director and also serves on the Executive Committee of the Michigan Neurological Association.
Ramesh Madhavan, MD DM is the Director of Telemedicine of the Wayne State University Physician Group and the Michigan Stroke Network. He is leading the effort for the incorporation of telemedicine, which has developed nationally and internationally as a reliable means of treating acute stroke patients. The WSU Physician Group provides services to the Michigan Stroke Network, an initiative of the Trinity Health and St Joseph Mercy Oakland Hospital and the Vanguard DMC hospitals. The network is one of the largest stroke networks in the country that use the hub and spoke model for providing comprehensive stroke care. The WSU stroke team, consisting of vascular and critical care fellowship trained neurologists, has been providing acute stroke coverage in DRH, Harper University Hospital and St. Joseph Mercy Oakland, which serve as hub hospitals and ‘spoke’ care to about 35 hospitals in the state of Michigan. When the Stroke pager is activated, the patient is assessed on site by the stroke team 24/7 and patient managed. The same principle is applied at off-site Community hospitals using telemedicine as a bridge. The patient is examined by one of the six stroke team attending physician with the help of a remote Tele-presence robot and the onsite ED physician. Images and results are seen remotely by the stroke neurologist and treatment decisions made. More acute stroke patients have received tPA, the only FDA approved clot busting treatment and interventional treatments in the network hospitals during the past years. Over the past 5 years, the project has been found to be effective and improved stroke care and outcomes in all participating hospitals. Dr Madhavan is also the Associate Chief Medical Officer of WSUPG, Informatics and is the consultant for a TATRC research grant. TATRC ( an office of the headquarters of the US Army Medical Research and Material Command) has funded the $1.6 million grant titled "Machine Learning-Based Multi-Tasking Management Solution for Civilian and Military Health Systems"
Andrew Xavier, MD jointly appointed in the Departments of Neurosurgery and Neurology, is an interventional neurologist and serves as a key resource for treatment of patients with ischemic or hemorrhagic stroke. Dr Xavier is leading the efforts to study mechanical devices for acute stroke treatment. Since the overall treatment for stroke is increasingly focusing on endovascular treatment, the addition of Dr Xavier has been very significant for the Stroke Program. Dr Sandra Narayanan is also a jointly appointed interventional neurologist in our program. Her major areas of interest are aneurysm treatment and acute stroke intervention. She was the lead author on a recent research presentation focusing on improving the “door to needle time” in patients with acute stroke seen at the Detroit Medical Center. Dr Samuel Tsappidi an interventional neurologist recently joined the program.
The NEUROCRITICAL CARE UNIT at Detroit Receiving Hospital is one of the leading Neurocritical Care programs in the country. Led byBenjamin Atkinson, MD, the neuro-intensive care unit (NICU) serves as a regional resource for patients with traumatic brain injury, hemorrhagic stroke, large ischemic strokes, and other life-threatening neurologic illnesses. The NICU is currently engaged in studies focusing on several areas, including novel treatments for brain hemorrhage and traumatic brain injury. Dr William Coplin, a board member of the NeuroCritical Care Society and an elected member of the American Neurological Association, is joined by Greg Norris, MD as the neurocritical care team