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Excellence In Stroke Clinical Care and Research: UPMC Stroke Institute Continues to Expand Clinical Access to Timely Care and Clinical Trials Availability for Patients

March 8, 2024

UPMC has a long and distinguished record of developing and implementing novel approaches to stroke treatment and advancing the field through innovative research into the mechanisms of stroke and how to treat it effectively.

The Expansive Clinical Reach of the UPMC Stroke Institute

The UPMC Stroke Institute is a national leader in stroke care and clinical stroke research, providing a comprehensive spectrum of services across a continually expanding geographic footprint in Pennsylvania and neighboring states, including Ohio, West Virginia, Maryland, New York, and New Jersey.

The UPMC Stroke Institute treats roughly 7,000 strokes each year, and it follows thousands more individuals in the post-acute environment, providing integrated longitudinal follow-up care and rehabilitation for stroke patients through multidisciplinary collaborations and clinical programs.

“UPMC is one of, if not the largest academic health care system in the U.S., uniquely integrating research and innovation into how we operate,” says Raul G. Nogueira, MD, FAHA, FSVIN, director of the UPMC Stroke Institute, Endowed Professor and Division Chief of Cerebrovascular Medicine, and Professor of Neurology and Neurosurgery at the University of Pittsburgh School of Medicine. “With a network of more than 35 hospitals, including five specializing in endovascular stroke treatments such as mechanical thrombectomy, we annually conduct between 500 to 600 of these life-altering procedures. Our volume of clinical work positions us as national leaders in stroke care. Our high patient volumes are essential for testing new treatment paradigms and approaches to acute stroke care, a strength that we leverage across the entire UPMC Stroke Institute and its work.”

With a commitment to excellence, the institute encompasses a comprehensive network of stroke-treatment capable hospitals, ensuring cutting-edge care is within reach for patients spread across the UPMC Stroke Institute network’s geography. The strategic placement of these sites underscores UPMC's continuing dedication to accessibility of advanced stroke treatment modalities, bringing these advances in stroke treatments closer to those in need.

The UPMC Stroke Institute Clinical Configuration

The institute’s expansive network is designed to cover the full range of stroke care—from acute intervention and emergent care to comprehensive post-stroke rehabilitation and long-term follow-up care. This widespread coverage not only facilitates timely and effective treatment for stroke patients but also integrates a robust support system for recovery and rehabilitation.

The UPMC Stroke Institute currently is comprised of three comprehensive stroke centers, with a total of five centers currently providing 24/7 thrombectomy coverage. The institute has a further 15 primary stroke centers spread across Pennsylvania along with three acute stroke ready hospitals.

“Those centers are all UPMC hospitals,” says Dr. Nogueira. “But our network also consists of six non-UPMC hospitals that provide various levels of stroke care and are integrated into our network, which allows us to cover even more territory. Furthermore, in the next couple of years, we’ll likely be adding another comprehensive stroke center to our next as well as additional improvements and growth.”

All this acute stroke care within the UPMC Stroke Institute is backed up by an exceptionally robust and expanding network of telestroke capabilities. Currently the UPMC Stroke Institute has telestroke capabilities embedded into 25 UPMC facilities and an additional 15 centers at affiliated non-UPMC hospitals.

“Telestroke is a critical component of our institute, one that we continually seek to expand to reach as many patients as possible, explains Dr. Nogueira. “We anticipate adding another four telestroke sites to our network during 2024.”

The UPMC Stroke Institute’s commitment to growth is evident in its continuous expansion, adding new sites and services to cater to the evolving needs of a diverse patient population. This growth is complemented by the adoption of innovative treatment modalities and research-driven approaches, ensuring patients receive the most advanced care available. This commitment is also evident in the partnerships and multidisciplinary collaborations that the UPMC Stroke Institute has with other groups within the UPMC system, like the UPMC Heart and Vascular Institute, but also with internal and external partners helping to shape the face of advancing clinical care and research into the mechanisms, treatment options, and prevention strategies around stroke.

Clinical Treatment and Diagnostic Areas of Emphasis

While the UPMC Stroke Institute is comprehensive in its composition and clinical array of treatment approaches for patients, there are several areas in which specific emphasis is brought to bear – in clinical treatment but also in related research – related to acute management and diagnosis, and in the realm of prevention.

These areas of emphasis include work around patients with transient ischemic attacks, and in patient populations subject to a higher risk for having a stroke. These include patients with atrial fibrillation, one of the biggest and increasing risk factors for an ischemic stroke in the general population. But also, those with carotid artery stenosis or disease. Indeed, Dr. Nogueira is one of the country’s leading experts in carotid artery disease and revascularization techniques, along with colleague Matthew T. Starr, MD, who is an associate director of the UPMC Stroke Institute and director of the comprehensive stroke center at UPMC Mercy, and the UPMC Stroke Institute routinely collaborates with colleagues from neurosurgery and vascular surgery on carotid endarterectomies to treat the disease and prevent the potential for a devastating ischemic stroke.

Stroke Care Wouldn’t Be Complete Without Comprehensive Rehabilitation

While great emphasis is placed on stroke prevention and rapidly diagnosing and treating strokes when they do happen – two of the most important factors in long-term outcomes, without a comprehensive, multidisciplinary, and coordinated plan of care and resources for rehabilitation needs after a stroke occurs no program is complete. The UPMC Stroke Institute has one of the largest rehabilitation programs of its kind – inpatient and outpatient. George Wittenberg, MD, PhD, who is dually trained in stroke neurology and stroke rehabilitation leads these efforts for the UPMC Stroke Institute. Dr. Wittenberg also serves as director of the Laboratory for Research on Arm Function and Therapy (RAFT) at Rehab Neural Engineering Labs.

“Our network's capabilities in acute stroke treatments and volumes, drives our outcomes success and our ability to conduct large-scale, impactful clinical studies,” says Marcelo Rocha, MD, PhD, program director of the NIH StrokeNet Regional Coordinating Center at the University of Pittsburgh and UPMC, associate director of clinical research at the UPMC Stroke Institute, and assistant professor of Neurology at the University of Pittsburgh. “Additionally, our academic potential allows us to bring new treatments to the forefront of stroke care. We excel in acute management and diagnosis, and significantly contribute to methodologies for stroke prevention. Our outpatient care, often with a heavy focus on secondary stroke prevention, is a critical component of our overall approach, especially for patients at high risk of stroke following events like TIAs. This approach underscores our institute's comprehensive strategy in tackling stroke from both clinical and research perspectives.”

UPMC's Role in Advancing Stroke Research through NIH-Funded StrokeNet

The UPMC Stroke Institute's involvement with the NIH-funded StrokeNet research collaborative exemplifies its leadership in the realm of stroke research. Since StrokeNet's creation by the NIH in 2012, UPMC has been an integral participant, contributing to the network's mission of optimizing stroke prevention, treatment, and recovery strategies through comprehensive clinical trials. This collaboration leverages UPMC's extensive network of hospitals, enabling a wide-reaching infrastructure for conducting pivotal stroke research.

“UPMC has been a part of every StrokeNet grant funding cycle since its inception,” says Dr. Rocha. “Including the most recent one in 2023. We continue to build upon the work that was started at UPMC in StrokeNet by our prior department chair and colleague Lawrence Wechsler, MD, who remains a leading figure in in the field, as well as one of our department faculty members.”

StrokeNet, designed as a consortium of 27 leading stroke centers in the U.S. with more than 500 participating hospitals, aims to streamline the research process, making it more efficient and effective. Through its participation in StrokeNet, the UPMC Stroke Institute facilitates a wide range of clinical trials, harnessing its vast network to gather significant data that informs the development of innovative stroke treatments and interventions as part of the collaborative’s ongoing work. This relationship not only enhances the institute’s research capabilities but also positions it as a key player in the global effort to combat stroke and devise innovative treatment approaches.

“One of the great abilities of the UPMC Stroke Institute network is that every one of our sites has the capabilities to participate in the clinical trials we manage as a StrokeNet regional coordinating center,” says Dr. Rocha. “This opens access to clinical trials for many more patients that would otherwise be possible. And that’s critically important for several reasons, not the least of which is working to improve inclusion of diverse and under-represented populations in clinical trials in stroke, which is a high priority for the NIH.”

The continuous support and funding from NIH for five-year grant cycles underscore the confidence in UPMC's capabilities and its contributions to StrokeNet's goals. The institute's ongoing involvement signifies a commitment to advancing the scientific understanding of stroke, improving patient outcomes through evidence-based treatments, and ultimately, paving the way for breakthroughs in stroke care.

Ongoing/Upcoming Clinical Trials Work

UPMC Stroke Institute’s clinical trials involvement in StrokeNet to date have encompassed a range of different trials examining important aspects of stroke clinical care and management. One trial, the MOST trial, which recently completed and for which results will be forthcoming explored how adding two categories of blood thinners in the acute phase could potentially enhance the effectiveness of thrombolytics, aiming for better patient outcomes.

“We’re currently looking at how we may be able to take part in clinical trials that will explore the use of a novel neuroprotective agents combined with reperfusion therapies, both clot-busting therapeutics and endovascular thrombectomy, to extend their benefits towards greater independence after stroke,” says Dr. Rocha.

Dr. Rocha also explains that along with colleagues in StrokeNet, Dr. Nogueria has an interest in trials and cutting-edge technology that will be designed to reach smaller clots farther in the brain with endovascular thrombectomy, and other treatment approaches that may be able to offer some of these stroke therapies to even more patients.

“That’s just a small sampling of what we are currently working on in StrokeNet and what’s to come. For example, Dr. Wittenberg is working on several recovery trials around motor function, which is so important to the overall care of many individuals who experience a stroke,” says Dr. Rocha.

It is also important to note the teaching aspect of UPMC Stroke Institute’s participation in StrokeNet.

“Our participation in StrokeNet allows for a dedicated 1-year research fellowship that allows talented trainees protected time for formal coursework in clinical research methods and academic career development in the stroke field,” says Dr. Rocha. “That’ really the other big aspect of not only our StrokeNet work, but the UPMC Stroke Institute as a whole – training new generations of capable, forward-thinking clinicians and scientists dedicated to solving the biggest challenges we face when someone has a stroke.”

As the UPMC Stroke Institute continues to grow and evolve within the StrokeNet framework, we will also continue to participate in collaborations with industry partners to continue to influence and shape the future of stroke treatment and research.

“Our clinical excellence and research innovation at UPMC not only enhances patient care but also contributes significantly to the global fight against stroke,” says Dr. Rocha.

Learn More

To learn more about the UPMC Stroke Institute, or to refer a patient for services or clinical trials, visit our website or call us at 412-232-8840. You can also complete our online contact form.