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TIME IS BRAIN.

A Proposal for

THE UCLA BRAIN STROKE RESCUE PROGRAM


2010 Presented by
Professor of Radiology and Neurosurgery, David Geffen School of Medicine at UCLA Director, Leo G. Rigler Center for Radiologic Research Co-Director, UCLA Stroke Center and Program

Fernando Viuela, M.d.

UCLA BRAIN STROKE RESCUE PROGRAM


DAVID GEFFEN SCHOOL OF MEDICINE AT UCLA

Time is brain.
One of the most miraculous moments in modern medicine is to open up a blocked vessel early enough, when the damage has not yet been severe, and then restore the blood flow and watch the incapacitated stroke patient return to a completely normal state. Every 45 seconds, someone in America has a stroke. Every 3.1 minutes, someone dies from one. Stroke is the third leading cause of death and the leading cause of serious, long-term disability in the United States. The economic costs of stroke have been estimated to exceed $50 billion a year. In a typical acute ischemic stroke, the brain loses 1.9-million neurons, 14-billion synapses, and 7.5 miles of myelinated nerve fibers every minute. In stroke, time really does equal brain. Every hour, the brain suffering a stroke loses 200-million nerve cells and ages nearly four years. While stroke strikes the population indiscriminately, age and vascular health are key factors. Our population is aging rapidly, and obesity is epidemic, making the need for rescue so relevant. Seventy-three million Baby Boomers had an increased susceptibility to severe stroke the minute they received their AARP card. Each year, those risks increase exponentially. Who doesnt have a friend or family member whose life has been affected by stroke? There are 4,400,000 stroke survivors in the United States alone. Every year, 750,000 people here have a stroke 150,000 resulting in death. The social impact upon families and the fiscal impact on our health care system are catastrophic, yet innovations in this field have been few and far between.

VISION
The UCLA Brain Stroke Rescue Program represents an opportunity to make a valuable investment in your future and the future of the people you love. Our program, with its multidisciplinary approach to treatment, is dedicated to developing new and pioneering ways to rescue people from the tragedy of stroke. Research has shown that speed, knowledge, technology, and efficacy at all touch points along the way from prevention, recognition, and transportation to treatment, post-treatment, and rehabilitation can make a profound difference in a stroke victims outcome. The UCLA Brain Stroke Rescue Program is about treating stroke faster and better. Neuronal damage is reversible early, but is progressive after stroke. There is a short therapeutic window for optimal treatment. The program utilizes integrated research and education to discover and develop new, innovative therapies for acute ischemic and hemorrhagic stroke. These groundbreaking investigations are made through a multidisciplinary collaboration of investigators from the disciplines of stroke neurology, emergency medicine, pre-hospital care, vascular neurosurgery, neuropathology, stroke genomics, diagnostic and interventional neuroradiology, magnetic resonance physics, and functional imaging. While UCLA is allied with the few stroke organizations that exist, there is currently no other entity dedicated to the comprehensive lifesaving, life-enhancing difference that our focus on rapid treatment can make. Our vision is to rescue people from the tragedy of stroke through a rapid treatment approach and multidisciplinary development of cutting-edge interventional and radiologic techniques. We appreciate your interest in joining with us to make the vision of the UCLA Brain Stroke Rescue Program a reality.

MISSION
The mission of the UCLA Brain Stroke Rescue Program is threefold:

1. To develop and build the first real-time Stroke Treatment Suite at Ronald Reagan UCLA Medical Center
The capacity to diagnose and treat the cause of stroke without moving the patient from room to room, floor to floor, over several blocks, or across town saves approximately 90 minutes of transfer time. These 90 minutes are critical to saving the patients life. Creating the worlds first real-time Stroke Treatment Suite (STS) at Ronald Reagan UCLA Medical Center is the first step in an important journey. With no stopping points along the way, the real-time STS will offer the very first direct route to lifesaving outcomes, addressing and helping to overcome the $50-billion annual impact of stroke. UCLA will serve as the model institution to assemble this kind of facility.

The dedicated STS will have a 3 TESLA (3T) magnetic resonance imagingpositron emission tomography (MRI-PET) unit, a rotating table, and a state-of-the-art Zeego angiography unit. PET is a nuclear medicine imaging technique that produces a 3-D picture of functional processes in the body; matched with MRI, more detailed information is provided. Patients will be transferred from the emergency room directly to the table located in the center of the STS. The table will be moved to the 3T MRI-PET unit, and an emergency MRI-PET will show the status of the brain and identify brain tissue to be rescued. The table will then be moved to the Zeego angio unit, and an immediate endovascular procedure will be performed, aiming to remove the cerebral clot and reestablish normal brain circulation. Stroke is a disease that progresses rapidly over the course of a few hours. Real-time imaging allows us to instantly identify the activity in every artery of the brain. Another major advantage of the STS is the ability to perform serial scans to guide therapy. The instant availability of an MRI-PET will help us decide whether further treatment is warranted and safe. There is solid evidence that certain types of early changes on MRI are predictive of clinical outcome, but the accuracy of the data could be improved substantially with access to real-time MRI-PET before, during, and after endovascular intervention. The use of real-time imaging and therapy for patients with acute stroke will reveal new knowledge of brain responses immediately after the reestablishment of blood supply to the brain, using interventional techniques. This new research information will be collected and reviewed by stroke neurologists, interventional neuroradiologists, neuro-intensivists, and neuroradiologists from the UCLA Brain Stroke Rescue Program. One miraculous room at UCLA will enable the brain power within the program to revolutionize the approach to stroke treatment, saving lives and thwarting disabilities.

2. To develop new interventional techniques to reestablish rapid normal brain circulation in patients with acute ischemic stroke
While there have been remarkable advances in the treatment of heart attacks and various forms of cancer, stroke remains one of the last unsolved, potentially fatal diseases. UCLA has been a pioneer in this area. Dr. Pierre Gobin was a member of the UCLA Division of Interventional Neuroradiology, when he developed the first Food and Drug Administration (FDA)-approved endovascular device for the mechanical treatment of acute stroke in 2000. The UCLA Brain Stroke Rescue Program will allow UCLA neuroscientists to build upon this success. It will support the development of new devices and techniques used in emergency procedures to treat the cause of acute blockage of brain arteries eliciting an acute stroke.

3. To develop new real-time MRI-PET techniques that will allow the accurate assessment of brain responses during and after the emergency reestablishment of normal circulation
Currently, the images that are available to be used for evaluating stroke patients are not real-time and, because of the delay, are not as effective for determining the best course of treatment. Real-time images will be the most important factor in the immediate management of the stroke, resulting in better outcomes for the patient.

GIVING OPPORTUNITIES
Development & Construction of Real-time Stroke Treatment Suite $12 million
A gift of $12 million will underwrite the development and construction of the STS and provide the funds to purchase and install the 3T MRI-PET unit and Zeego angiography unit. The funding for this 16-month project includes architectural and mechanical drawings, construction, and installation of the equipment. A time line and construction budget of $11.39 million is attached. The remaining funds will be used to purchase advanced neurointerventional devices and other specialized equipment to perform therapeutic procedures.

Funding of Research

$3 million

Additional funding in the amount of $3 million will support cutting-edge research that will result in the development of new real-time MRI-PET techniques to assess brain responses during stroke and new interventional techniques to reestablish normal brain circulation.

ADDENDUM
The UCLA Brain Stroke Rescue Program comprises some of the leading experts and innovators in the field of modern diagnosis and management of acute cerebral stroke. Fernando Viuela, M.D. Co-Director Born in Mercedes, Uruguay, on April 5, 1945, Dr. Fernando Viuela received his M.D. degree from the University of Uruguay in December 1970. He completed his post-medical education at the University of Western Ontario, Canada, from 1974 to 1979. He arrived at UCLA in July 1986 as Professor of Radiology and Director of the Division of Interventional Neuroradiology and is also currently Professor of Neurosurgery, Director of the Leo G. Rigler Center for Radiologic Research, and Co-Director of the UCLA Stroke Center and Program. Among Dr. Viuelas academic achievements to date, he has presented 337 lectures on ischemic and hemorrhagic strokes at national and international meetings and has authored or co-authored 294 manuscripts in peer-reviewed journals and six book chapters focusing on ischemic and hemorrhagic strokes. He has been awarded 40 industry and National Institutes of Health (NIH) contracts and grants on research related to his field of expertise, as well. Dr. Viuela is a founding member and president of the American Society of Interventional Neuroradiology, World Federation of Interventional Neuroradiology, and Ibero-Latin American Society of Diagnostic and Therapeutic Neuroradiology. In addition, he is an honorary member of 19 scientific professional organizations, including the Japanese Society of Interventional Neurosurgery, Russian Society of Neurosurgery, and Peruvian Society of Neurosurgery.

Jeffrey L. Saver, M.D.


Co-Director Dr. Jeffrey Saver, Professor of Neurology, David Geffen School of Medicine at UCLA and director of the UCLA Stroke Center and the UCLA Stroke and Vascular Neurology Program, earned his medical degree at Harvard Medical School and completed his internship in Medicine and residency in Neurology at Brigham & Womens Hospital. His fellowship in Cognitive Neuroscience was done at the University of Iowa Hospitals and Clinics and in Cerebrovascular Disease at Rhode Island Hospital. He is board-certified in Neurology, Vascular Neurology, and Addiction Psychiatry. Dr. Savers research focuses on the prevention, diagnosis, and treatment of stroke; neuroimaging; clinical trial design; and neurocognitive consequences of stroke. His work has been supported by grants from the National Institutes of

Health, National Institute of Neurological Disorders and Stroke, the American Heart Association (AHA), and the National Stroke Association. He is the author or co-author of more than 175 research articles. Among his many accolades, in 2010, he was named Physician Volunteer of the Year, one of the top honors given by the AHA to volunteers in the Western States Affiliate, which covers California, Nevada, and Utah. It is given to an individual who has demonstrated the most distinguished commitment and service to the AHA during the past fiscal year and over time. He was recognized for his years of exemplary service to the AHA/American Stroke Association at the national, affiliate, and division levels. In particular, Dr. Saver was cited for his tireless efforts in establishing true stroke systems of care in Los Angeles over the last 10 years. His work was instrumental in the Emergency Medical Service Commissions passage of a new stroke destination policy in Los Angeles that recognizes primary-stroke-center status as a factor for selecting a receiving hospital for a stroke patient. He also has been acknowledged for his accomplishments as chair of the California Stroke Work Group. Under his leadership, the members recently completed stroke system implementation recommendations, a model document that will raise the standard of stroke care throughout the State of California. Dr. Saver, who has served on several national AHA committees, recently published research noting improved outcomes in hospitals, using the AHAs Get With The Guidelines, a stroke quality improvement program.

Medical Advisory Committees


Chairman Education Jeffrey L. Saver, M.D. Nestor Gonzalez, M.D. Sidney Starkman, M.D. Imaging Developments Noriko Salamon, M.D., Ph.D. J. Pablo Villablanca, M.D. Telemedicine Therapeutic Innovations Latisha Ali, M.D. Gary R. Duckwiler, M.D. David S. Liebeskind, M.D. Satoshi Tateshima, M.D., Ph.D. Translational/Clinical Research S. Thomas Carmichael, M.D., Ph.D. Nestor Gonzalez, M.D. Reza Jahan, M.D. Neuro-critical Care Neuronal Repair and Rehabilitation Paul M. Vespa, M.D., FCCM, FAAN S. Thomas Carmichael, M.D., Ph.D. Bruce Dobkin, M.D.

STROKE TREATMENT SUITE

Stroke Treatment Suite 3T MRI-PET

Stroke Treatment Suite

TIME IS BRAIN
Time Line Budget
Month 1 Month 2 Month 3 Months 4 14 Month 15 Month 16 TOTALS

UCLA Construction

Initiate Project $27,000 $163,000 $2,200,000

Architectural & Mechanical Drawings

Construction

Seimens Healthcare Order equipment $4,000,000 $900,000 $27,000 $163,000 $7,100,000 $4,100,000 $11,390,000 $4,100,000

Order MRI-PET & Zeego

Install Equipment

TOTALS