A Stroke Team Leader Counts Many Blessings and Thanks His Parents

Man poses for photo

Joseph Broderick, MD, photo by Cindy Starr / Mayfield Clinic

Joseph Broderick, MD, has much to be thankful for this Thanksgiving holiday. Beyond his own good health and that of his thriving family, 2011 has seen him mark one career milestone after another. Multi-million-dollar stroke research grants have been awarded to his department or renewed, and he has been richly acknowledged for his leadership in what may well be America’s premier stroke research program.

Dr. Broderick, the Albert Barnes Voorheis Chair of Neurology at the UC College of Medicine and Research Director of the UC Gardner Neuroscience Institute, can point to the following accomplishments at UC during 2011:

  • The awarding of $12.7 million over the next four years from the National Institutes of Health to continue coordinating an international study of different approaches to the treatment of ischemic stroke, an acute stroke caused by a blood clot.
  • The naming of UC and Cincinnati Children’s Hospital Medical Center by the National Institute of Neurological Disorders and Stroke as one of 24 federal clinical sites in the Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT). The Cincinnati collaboration, which includes UC Health / University Hospital, will receive $2.2 million in funding over seven years. Pooja Khatri, MD, Associate Professor of Neurology, and Tracy Glauser, MD, Professor of Pediatrics and Neurology and Director of the Comprehensive Epilepsy Center at Cincinnati Children’s, are Cincinnati’s principal investigators of the NEXT trial.
  • The opportunity to provide distinguished commentary in two prestigious medical journals, the New England Journal of Medicine and JAMA: The Journal of the American Medical Association.
  • The honor of becoming the first stroke researcher ever to receive the American Heart Association’s Clinical Research Prize.

“All of those different events represent our team’s effort,” Dr. Broderick says.  Even the individual Heart Association award, he says, is an award for the Greater Cincinnati-Northern Kentucky Stroke Team at UC, an ambitious group of 50-plus physicians, nurses, technicians and basic scientists in multiple departments.

“The award reflects the fact that a lot of great things have happened in stroke over the last 25 years — in treatment and in our understanding of the condition,” Dr. Broderick says. “And our group here in Cincinnati has been one of the key players in the world in moving stroke treatment forward. That is very gratifying.”

In accepting the award at the American Heart Association’s Scientific Sessions in Orlando, Fla., Dr. Broderick thanked patients and their families who have “the courage to make the difficult decision to participate in clinical stroke studies” at a time when they are confronting a sudden and potentially life-threatening medical emergency. “Seventy percent of patients in acute stroke trials cannot provide consent because of their inability to communicate or because they lack understanding that they even have a deficit,” Dr. Broderick said. “Thus the burden of decision-making falls on family members, who have a very limited time to decide.”

Their willingness to enroll in clinical studies at this desperate time, Dr. Broderick says, allows science to find out what works and what doesn’t work. “Their children and grandchildren, and our children and grandchildren, will have better treatments because of that. But it doesn’t happen without people deciding to participate.”

Dr. Broderick says the Stroke Team today is “as big and broad and impactful” as it has ever been. Yet perhaps nothing will equal the exhilaration that accompanied the team’s breakthrough clinical testing of intravenous tissue plasminogen activator (t-PA), the clot-busting drug, in the late 1980s through the mid 1990s.

“When we did the work with t-PA and stroke, that really changed medical practice since there had been no scientifically proven treatment for acute stroke before t-PA,” Dr. Broderick says. “That doesn’t happen very often in anyone’s career, so I think that while we are even bigger as a research and clinical group today, that particular contribution remains unique.”

At the forefront of clinical stroke research today is the Interventional Management of Stroke (IMS III) trial, which compares two therapies: 1) intravenous administration of t-PA and 2) intravenous administration of t-PA combined with intra-arterial treatment, in which an endovascular radiologist, neurosurgeon or neurologist threads a catheter up to the offending clot and uses a mechanical device to break it up or remove it completely. At this time, physicians do not know which therapeutic approach is superior.

“The IMS III study is right now probably the most important ongoing acute stroke study in the world,” Dr. Broderick says.

Dr. Broderick’s commentary in JAMA and the New England Journal of Medicine involved two other national clinical stroke trials, both involving a cross-disciplinary team of UC Gardner Neuroscience Institute researchers, who found that more intervention and technology aren’t always better for patients.

  • The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study found that for patients with narrowed intracranial arteries who had already suffered a minor stroke or transient ischemic attack, treatment with intensive management with medications and behavioral modification was superior to treatment with medications, behavior modification and a stent that props open the artery.
  • The Carotid Occlusion Surgery Study (COSS) found that a surgical bypass operation that doctors hoped would prevent strokes in people with a complete blockage of one of their two carotid arteries did not improve outcomes for these patients.

What lies ahead in 2012? In addition to continuing the 20 clinical trials now in process at UC, the Stroke Team will be hosting the Princeton Conference, the oldest academic stroke conference in the world, May 17-19, at the Cincinnati Hilton Netherland Plaza.

“It will feature a great interchange of science,” Dr. Broderick says. “It’s not a typical meeting where people talk for an hour and then someone asks questions for two minutes. Basically, you talk for 10 minutes and then people will argue the question for the next 15 or 20. You have more interaction, and that’s what I think makes it especially interesting and fun.”

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