How can analysis of acute thrombi from stroke patients be used to advance therapeutic options for cerebrovascular disease? That is one of the questions Peter Adamczyk, MD, hopes to answer as part of his research for the AAN Foundation Clinical Research Training Fellowship.
A graduate of the Northwestern University Feinberg School of Medicine, Dr. Adamczyk completed his neurology residency at the University of California-Davis in 2009. Currently, he is a Fellow Physician at the UCLA Medical Center.
As part of his AAN fellowship grant, Dr. Adamczyk will evaluate brain blood clots removed by catheters in stroke patients and their influence on patient outcomes.
Dr. Adamczyk spoke with Neurology Today about his research on acute stroke and his unrelenting fascination with the human brain.
WHAT IS THE FOCUS OF YOUR RESEARCH?
Our research aims to analyze thrombi retrieved by catheters from our patients who suffer an acute stroke. Based on prior work, we know that thrombi are comprised of red blood cells, platelets, fibrin, calcium, etc. in varying proportions. But the correlation of histological composition to the biomechanical and radiographic properties of these specimens is poorly understood. We hope to shed light on this relationship as well as the potential influence of these factors on recanalization and clinical outcomes as it may help guide future revascularization strategies.
HOW ARE YOU APPROACHING THIS PROBLEM?
Upon retrieval, our specimens will undergo applied mechanical stress to acquire quantitative data commonly used in materials science testing. Additional sample material will then be sent for quantitative and qualitative histopathologic analysis. The information will be compared with data obtained from acute radiographic and clinical evaluations. This investigation may allow us to better predict how thrombi behave when mechanical forces are applied during endovascular recanalization. We hope this knowledge will ultimately contribute to the development of improved methods to effectively restore vital blood flow in future stroke victims.
WHY DID YOU CHOOSE TO EVALUATE ACUTE THROMBI FOR YOUR RESEARCH QUESTION?
We've seen an explosion in the number of new potential treatments for acute stroke, including novel fibrinolytics and endovascular devices. But most of these strategies focus on removing or reducing the thrombus in order to restore blood flow. And, while trials for these therapeutic options remain underway, my research aims to evaluate the fundamental properties of various thrombi. I felt that this may shed light on the intrinsic properties of thrombi to possibly determine why certain treatments may be superior [to others].
HOW IS THIS PROJECT UNIQUE?
Ultimately, I think our methods will closely resemble in vivo analysis of acute thrombi in humans, which is very difficult given the urgency of treating these patients. Currently, it remains impractical to perform an in vivo analysis of acute thrombi, but this project will allow us to evaluate retrieved thrombi immediately after removal.
WAS THERE A PARTICULAR PATIENT THAT INSPIRED YOUR INTEREST?
One of the first stroke patients I treated here [at UCLA] was a young woman who arrived in our emergency room with severe left hemiparesis and neglect. She received IV tPA within two hours of onset, but continued to deteriorate neurologically. We elected to use mechanical thrombectomy to remove the occlusion in her cerebral artery, and the patient returned to her baseline shortly after. She was so grateful to have all her functions intact again, and I was reminded of the importance of stroke neurology. We now possess many important tools in our armamentarium to help restore the lives of our stroke patients.
DO YOU HAVE A MENTOR WHO HAS INFLUENCED YOU?
I have several mentors. My principal mentor for this project, however, would be Dr. Jeffrey Saver, the director for our UCLA Stroke Program. His leadership for our program and his personal mentorship for me have been very inspirational. He is a pioneer in stroke treatment — both in medical advances and patient advocacy. His efforts have been instrumental in developing UCLA into a prominent stroke center that utilizes novel means, such as telemedicine and direct physician-to-EMS coordination, in order to better serve our patients in southern California. And through these efforts and innovations, he has made me more excited to be a part of this work.
HOW DID YOU DECIDE ON STROKE NEUROLOGY?
My interest in stroke stemmed largely in part from the research work that I did with Dr. Frank Sharp at UC Davis. He's involved in a lot of exciting research regarding gene expression profiling with stroke patients, and there was a lot of breakthrough work being done in this subspecialty [while I was at UC Davis]. Out of all the different neurologic subspecialties, stroke neurology has rapidly advanced and I think that there's still a lot of room for it to grow — so I want to be a part of that.
PLEASE TELL US SOMETHING ABOUT YOURSELF THAT YOUR COLLEAGUES MAY NOT KNOW OR FIND SURPRISING.
Prior to medical school, I was a disc jockey, and that's actually a hobby that I enjoy tremendously. I still try to DJ various parties and functions whenever I can — whenever I have the time. It probably doesn't influence my work directly, but it is a fun fact that many of my medical colleagues probably don't know about me. I love all types of music (I am also a violinist) and I really enjoy interacting with people, so this [DJing] is an exciting way for me to combine the two interests when I'm not working.
AAN Clinical Research Training Fellowships are funded by the AAN, the AAN Foundation, and the AAN Foundation Corporate Roundtable, and provide $55,000 per year for two years, plus $10,000 per year for tuition to support formal education in clinical research methodology at the fellow's institution or elsewhere. Fourteen fellowships were awarded for 2011, and more than 70 training fellowships have been awarded through the program since its inception in 1996. For more information about the program, visit http://bit.ly/egrG8L.