Neurology

Peter O’Donnell Jr. Brain Institute

Stroke/Cerebrovascular

The Stroke and Cerebrovascular Diseases and Stroke section focuses on the diagnosis and treatment of vascular-mediated damage to the central nervous system (CNS). While ischemic and hemorrhagic strokes are the most common condition managed by the Stroke and Cerebrovascular Diseases and Stroke section, we have a long history of caring for patients with conditions such as Moyamoya disease, carotid/vertebral artery dissections, intracranial cerebral atherosclerosis and CNS vasculitis.

Clinical 

The Cerebrovascular Diseases and Stroke program has been in practice since 1988. Our team cares for patients in the inpatient and outpatient services at Parkland Memorial Hospital and William P. Clements, Jr. University Hospital within the UT Southwestern system. 

Research

The Cerebrovascular Diseases and Stroke section conducts local and national clinical trials, registry, and outcomes research, including landmark studies in the care of patients with stroke and cerebrovascular diseases.

We have conducted trials that have helped answer fundamental questions regarding carotid disease, intracranial large vessel disease, acute care of stroke patients, effect of glucose control, hypertension in acute stroke patients, and the use of antiplatelet and anticoagulant medications in the care of stroke patients.   

  1. IST – Lancet 1997; 349:1569-81 
  2. NASCET – NEJM 1998; 339:1415-25 
  3. AAASPS – JAMA 2003; 289 (22):2947-2957 
  4. VISP – JAMA 2004; 291:565 
  5. WASID – NEJM 2005; 352:1305-1316 
  6. SONIA – Neurology 2007; 68:2099-2106 
  7. SAMMPRIS – NEJM 2011; 365 (11) 993-1003 
  8. SWISS – Stroke 2011; 42:2726-2732 
  9. COSS – JAMA 2011; 306; 18:1983-1992 
  10. SPS3 – NEJM 2013 368:1092-1100 
  11. CRYSTAL AF – NEJM 2014 370; 2478-86 
  12. IRIS – NEJM 2016; 374:1321-31 
  13. NAVIGATE ESUS – NEJM 2018 378; 23: 2191-2201 
  14. POINT – NEJM 2018; 379; 3:215-225 
  15. RHAPSODY – Annals of Neurology. 2019; 85 (1):125-136 
  16. MyRIAD – Journal of Stroke and Cerebrovascular Diseases 2021 30 (2): 105504 

Our section has led the ARAMIS registry, nationwide quality improvement efforts, and have received funding from: 

  • National Institute on Aging 
  • American Heart Association/American Stroke Association 

Sample of recent publications 

  • Good outcome associated with blood-brain barrier disruption and lower blood pressure after endovascular therapy. Journal of Stroke and Cerebrovascular Diseases. Volume 32, Issue 1, 2023, 106870, ISSN 1052-3057 
  • Analysis of Prescriptions for Dual Antiplatelet Therapy After Acute Ischemic Stroke. JAMA Netw Open. 2022;5(7):e2224157.  
  • Outcomes After Endovascular Thrombectomy With or Without Alteplase in Routine Clinical Practice. JAMA Neurol. 2022 Jun 13 
  • Evaluation of Evidence-Based Dual Antiplatelet Therapy for Secondary Prevention in US Patients With Acute Ischemic Stroke. JAMA Internal Medicine. Published online March 28, 2022 
  • Association of Recent Use of Non-Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA. 2022 Feb 22;327(8):760-771. 
  • Association of distal hyperintense vessel sign and recurrent stroke in patients with symptomatic intracranial stenosis. J Stroke Cerebrovasc Dis. 31(9):106616, 2022 
  • Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention. Stroke. 2021 
  • Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure. Stroke. 2021 
  • Racial and Ethnic Disparities in Functional Outcome after Thrombectomy: A Cohort Study of an Integrated Stroke Network. Journal of Stroke and Cerebrovascular Disease. Dec 2021 
  • Racial Disparities in Post-Stroke Functional Outcomes in Young Patients with Ischemic Stroke. Journal of Stroke and Cerebrovascular Disease. Aug 2020 

Education

For decades, our faculty has actively been teaching medical students and fellows in the acute care of stroke patients 24/7 coming to our institutions of care from the DFW and North Texas areas. Our teaching has included the management of complex cerebrovascular disorder and the prevention of recurrent stroke. 

Conditions Treated

The Cerebrovascular Diseases and Stroke section is committed to providing comprehensive, compassionate, efficient, high-quality care to our patients and their families. We are consulted for the assessment of acute stroke patients and the care of other conditions including:

  • Stroke
  • CNS Vasculitis
  • Fibromuscular Dysplasia
  • CADASIL
  • Moyamoya disease
  • Extracranial Carotid and Vertebral Atherosclerotic Disease
  • Intracranial Atherosclerotic Disease (ICAD)
  • Carotid and Vertebral Dissections
  • Stroke in patients with cardiac conditions of PFO and Atrial Fibrillation
  • Cerebral Venous Sinus Thrombosis  

Primary and Collaborative Services

The Cerebrovascular Diseases and Stroke section offers Transcranial and Carotid Duplex in the diagnostic assessment of patients with stroke. We often collaborate with departments including Cardiology, Hematology, Neurosurgery, Neurointerventional, Rheumatology, and Physical Medicine and Rehabilitation in the patient care continuum.   

Co-Section Heads

Mark Johnson, M.D. & Ying Xian, M.D., Ph.D.

Providers 

Clinical Trials

Vascular Neurology Fellowship Page