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Emory neurology faculty again prove worldwide leadership in stroke treatment

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Elizabeth Johnson

One year ago, Michael Frankel, MD, professor of neurology at Emory University School of Medicine, received notice that one of the country's largest insurance providers would no longer pay for a procedure he and his team confidently believed would improve outcomes for stroke patients.

Frankel, who is director of the Marcus Stroke and Neuroscience Center at Grady Memorial Hospital, was in the middle of clinical trials to prove the benefits of using a new thrombectomy procedure – a catheter-based approach to directly remove blood clots in the brain using stent-retriever technology.

Within weeks of the insurance company's announcement, the data generated by Frankel and his Grady team demonstrated conclusively this approach's ability to save lives and improve outcomes for stroke patients. 

In June of 2015, the insurance decision was reversed, largely because of the results that came from the clinical trials at Grady and other international sites. Today, Frankel's team has a 93 percent success rate acutely re-establishing cerebral blood flow using the thrombectomy procedure it pioneered to prevent damage and death caused by stroke. As a result of the team's experience with this new technique, the Grady-based center has become the Southeast's destination site for patients suffering from acute ischemic stroke. 

This procedure is the second major medical breakthrough to come from Emory's team at Grady. In 1995, Frankel's group proved the benefit of using intravenous t-PA – a clot-busting medicine – in the treatment of stroke patients.

"It's rare for a hospital to play a key role in one innovation of this magnitude, let alone two within 20 years of each other," said Frankel.

Since discovering the benefits of t-PA in acute ischemic stroke, Frankel and his team have been training other Georgia hospitals as part of the Centers for Disease Control and Prevention's Paul Coverdell Acute Stroke Registry. Currently there are nearly 70 participating hospitals across the state.

Frankel and his team are currently working on methods to extend the effectiveness of the thrombectomy procedure beyond the first six hours of stroke symptom onset. Frankel's colleague Raul Nogueira, MD, who is an associate professor of neurology at Emory and director of Grady's neuroendovascular service, is leading an international clinical trial to determine whether patients who are between six and 24 hours from symptom onset will benefit from thrombectomy. The trial, called DAWN, utilizes advanced CT perfusion imaging to improve patient selection.

Frankel is the 2015 recipient of the Society of Vascular and Interventional Neurology's Neurologist Pioneering Award. He was recently honored by Emory's School of Medicine for having two peer-reviewed publications, related to his work with t-PA, with more than 1,000 literature citations.

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