Gates Vascular Institute

Buffalo, NY, United States

Gates Vascular Institute

Buffalo, NY, United States
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News Article | January 21, 2016

Projections released by the U.S. Department of Education paint a bright future for jobs in the science, technology, engineering and mathematics (STEM) fields. As populations grow, natural resources diminish, disease prevention and treatment become more complex and evolutionary and universal mysteries continue to be explored, science and technology will remain critical to expanding human knowledge and solving challenges of today and for the future. Opportunities abound for STEM graduates today, but preparing enough STEM graduates to drive the scientific breakthroughs and technological innovations of tomorrow will be a daunting task for colleges and universities across the country. The U.S. President’s Council of Advisors on Science and Technology predicts that in the next decade, we will need approximately 1 million more STEM professionals than we will produce at our current rate. Currently, about 300,000 graduates obtain Bachelor and Associate degrees in STEM fields every year. In order to create this new workforce of 1 million additional STEM experts, that number needs to increase by 100,000 annually. The challenge is clear: Universities must attract more students to STEM programs. However, once these students have enrolled, another challenge begins to unfold: Only about 40 percent of students who enroll in STEM programs graduate with STEM degrees. The remaining 60 percent switch to non-STEM fields or drop out of college entirely. To address the challenges of attraction and retention, educational institutions throughout the country are trading in traditional teaching methods for new pedagogical techniques. These new methods move beyond a model where students passively listen to lectures and cram for tests, to methods that engage students in activities, enable collaboration across STEM disciplines and encourage students to use their hands just as much as their heads. With these new approaches to learning and teaching come new approaches to designing learning environments. These new spaces are eliminating the stereotypes associated with traditional STEM classrooms and fostering the type of creative brilliance that can help us educate and prepare one million new STEM graduates. Here are three ideas every university should consider when rethinking their STEM learning spaces to better recruit and retain students for the future. Get out of the basement Traditionally, STEM teaching labs and research spaces were located in building cores or basements. These underground “lairs” were uncomfortable and uninviting to students and faculty using these facilities. They featured little to no windows, no natural light and the overall environment felt more institutional than educational. For students that didn’t have a class assigned to these spaces, the labs were relatively unknown, and were considered untouchable and intimidating. Countless studies show the design of classroom environments influence students’ motivation and learning, and universities are seeing the value in encouraging the student body to observe the scientific process to raise curiosity and interest. From a design perspective, we use the term “putting science on display” pretty regularly. The general idea is to place science classrooms and labs in public, high-traffic areas. Instead of solid walls, expansive floor-to-ceiling windows celebrate the sciences and allow passersby the opportunity to observe research and watch it unfold. This helps make science an approachable, open process, and as an added benefit, it gives universities the chance to show off their cool research equipment. The University of Buffalo has embraced this idea with its Clinical Translational Research Center (CTRC). Embedded in the same building as Kaleida Health’s Gates Vascular Institute, the CTRC uses interior glass throughout the building to show science in an open, transparent process. Embrace startup culture A key component of successful STEM programs is experimentation. For example, if you look at the most successful technology startups over the last 10 years, very few started in a formal academic settings. More often than not, they started in garages or coffee shops—places with more sofas than fixed bench space. There’s a lot STEM learning environments can learn from these spaces, specifically in how they encourage free thinking and experimentation. Taking inspiration from startups, our team at CannonDesign is seeing an increase in makerspace, hackerspace and innovation hubs within STEM buildings. These spaces serve a pretty basic purpose: nurturing creativity, encouraging experimentation and stimulating intellectual inquiry in an informal setting. They don’t act exclusively as labs, garages or workshops, but they do include many of the tools found in these space (3-D printers, welding machines, computers, building materials). The Univ. of Utah sees the value in such spaces with their new Lassonde Studios Entrepreneurial building that features a 20,000-sf making/planning/hacking space to foster interdisciplinary and cross-disciplinary “mash-ups” extending beyond STEM disciplines and including others, such as business majors. Infuse appropriate technology into S&T academic environments Millennials and Generation Z grew up in a digital world and expect to take full advantage of technology in every aspect of life, especially college. However, technology hasn’t revolutionized education the way it has other industries. STEM learning environments can be leading examples for how using technology can enhance learning by making it more engaging and accessible. The flipped classroom is a good example of an effective use of technology for enhanced learning. The flipped classroom is a pedagogical model that has students watch video lectures and complete homework prior to class. Doing this creates richer face-to-face interactions when students are actually in class; instead of listening to a lecture, they spend their time asking questions, participating in hands-on activities and even getting involved in real university research efforts. On the most dramatic end of the spectrum, some universities are using virtual reality, simulation and gaming to inspire and educate future STEM innovators. These tools allow students to quite literally take part in technology. For example, CAVE environments, which are rooms wrapped in screens that project 3D virtual environments, allow students to immerse themselves in a setting and actually interact with what they’re seeing. From an infrastructure design standpoint, these technology-rich spaces require a building that provides enhanced server space, room for complex computing platforms, and the power and cooling sources to keep everything up and running. One interesting trend our team is also seeing related to technology is a decrease in dedicated computer labs. Prior to the days of constant connectivity, computer labs acted as the hub of higher education buildings. But today, 90 percent of students own a laptop, 86 percent of students own a smartphone and 47 percent of students own a tablet. The need to access university-owned equipment is dwindling, and the need to plug in personal devices and work anywhere is the new norm. There’s no denying universities need to prove themselves up to the challenge of attracting and retaining the much needed next generation of STEM professionals. How they choose to design their STEM learning environments can play a big role in helping them meet this challenge and exceed current projections. Stephen Blair leads CannonDesign’s global science and technology practice, focused on helping academic and corporate institutions design solutions that turn challenges into opportunities for success.

Mokin M.,State University of New York at Buffalo | Mokin M.,Gates Vascular Institute | Morr S.,State University of New York at Buffalo | Morr S.,Gates Vascular Institute | And 13 more authors.
Journal of NeuroInterventional Surgery | Year: 2015

Background Neurointerventionalists do not agree about the optimal imaging protocol when evaluating patients with acute stroke for potential endovascular revascularization. Preintervention cerebrovascular blood volume (CBV) has been shown to predict outcomes in patients undergoing intra-arterial stroke therapies. Objective To determine whether CBV can predict hemorrhagic transformation and clinical outcomes in patients selected for endovascular therapy for acute ischemic middle cerebral artery (MCA) stroke using a CT perfusion (CTP)-based imaging protocol. Methods We retrospectively reviewed cases of acute ischemic stroke due to MCA M1 segment occlusion and correlated favorable clinical outcomes (modified Rankin scale (mRS) ?2) and radiographic outcomes with preintervention CBV values. All patients underwent whole-brain (320-detector-row) CTP imaging, and absolute CBV values of the affected and contralateral MCA territories were obtained separately for the cortical and basal ganglia regions. Results Relative CBV (rCBV) of the MCA cortical regions was significantly lower in patients with poor clinical outcomes than in those with favorable clinical outcomes (0.87±0.21 vs 1.02±0.09, p=0.0003), and a negative correlation was found between rCBV values and mRS score severity. rCBV of the basal ganglia region was significantly lower in patients with hemorrhagic infarction (p=0.004) and parenchymal hematoma (p=0.04) than in those without hemorrhagic transformation. Conclusions We found that cortical CBV loss is predictive of poor clinical outcomes, whereas basal ganglia CBV loss is predictive of hemorrhagic transformation but without translation into poor clinical outcomes. Our study findings support published results of baseline preintervention CBV as a predictor of outcomes in patients undergoing intra-arterial stroke therapies.

Dumont T.M.,State University of New York at Buffalo | Dumont T.M.,Gates Vascular Institute | Mokin M.,State University of New York at Buffalo | Mokin M.,Gates Vascular Institute | And 11 more authors.
Journal of NeuroInterventional Surgery | Year: 2014

Objective: Several studies have reported increased perioperative risk after carotid artery stenting (CAS) for patients ≥80 years of age; however, most have not considered unfavorable anatomic features noted more frequently in this population as a confounding variable. The purpose of this study was to show a correlation between poor aortic arch anatomy and perioperative ischemic complications after CAS. Methods: Our prospectively maintained database was queried for all CAS procedures performed on symptomatic patients between 2009 and 2011. Retrospective analysis of consecutive CAS procedures was performed. The primary endpoint was perioperative (within 30 days) ischemic events (stroke, transient ischemic attack (TIA)). Event incidence was compared between groups dichotomized by age and anatomical features. Incidence of unfavorable arch (acute angle between aortic arch and treated common carotid artery) was compared between age groups. Results: Perioperative ischemic events included four ischemic strokes and three TIAs (all events ipsilateral to the treated vessel). Event incidence was more frequent in patients with unfavorable arch anatomy (7.9%) than in those with favorable aortic arch features (0.7%) (p=0.0073). Event incidence in patients ≥80 years of age (4.5%) was not statistically different than that in patients <80 years (2.3%) (p=0.428). Unfavorable aortic arch anatomy was increased in frequency in patients aged 80 years and over (<80 years, 29%; ≥ 80 years, 52%; p<0.001). Conclusions: In the present series, the incidence of perioperative complications was increased in patients with unfavorable aortic arch anatomy but not in patients ≥80 years. CAS represents a revascularization option for patients of all ages; however, patients with unfavorable aortic arch anatomy may represent a group at relatively high risk for periprocedural ischemic events.

Mokin M.,State University of New York at Buffalo | Mokin M.,Gates Vascular Institute | Snyder K.V.,State University of New York at Buffalo | Snyder K.V.,Gates Vascular Institute | And 9 more authors.
Journal of NeuroInterventional Surgery | Year: 2015

Background Challenging anatomy for carotid artery access can result in a delay to achieve successful recanalization in patients with acute ischemic stroke. Our objective was to study emergent direct percutaneous carotid artery puncture as an alternative access approach for acute endovascular stroke interventions. Methods We reviewed cases of acute ischemic stroke in which direct carotid artery puncture was used for access. We also reviewed current literature relevant to this subject. Results We describe the technical aspects, limits, and potential complications associated with direct carotid artery puncture for intracranial acute ischemic stroke interventions, and present cases to illustrate the utility of this access approach. Conclusions Direct carotid artery puncture is a feasible alternative to transfemoral artery access in cases of stroke with difficult anatomy, including unfavorable arch type, carotid tortuosity, or an ostial lesion.

Dumont T.M.,State University of New York at Buffalo | Dumont T.M.,Gates Vascular Institute | Kan P.,State University of New York at Buffalo | Kan P.,Gates Vascular Institute | And 9 more authors.
Neurosurgery | Year: 2012

BACKGROUND: The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study stopped recruiting patients because of higher-than-expected perioperative morbidity of primary stenting in patients with symptomatic intracranial stenosis. An alternative treatment, submaximal angioplasty without stenting, performed concurrently with SAMMPRIS, may offer revascularization benefits with a lower incidence of stenting-related risks. OBJECTIVE: To present the results of a consecutive case series of primary submaximal angioplasty procedures performed for symptomatic severe atherosclerotic intracranial stenosis refractory to medical treatment. METHODS: A database review identified primary submaximal angioplasty procedures performed in 41 patients for the treatment of >70% intracranial stenosis associated with an acute, symptomatic ischemic event in the distribution of the diseased vessel. For results analysis, 30-day events were reported as a percentage of patients treated. One-year periprocedural and ischemic event - free survival was reported as a percentage of all patients treated and displayed graphically with a Kaplan-Meier survival curve. RESULTS: Three events in 41 patients included 1 intraprocedural vessel perforation, 1 reperfusion hemorrhage <24 hours postoperatively, and 1 transient ischemic attack 3 months postprocedurally (30-day event rate, 2 of 41, 4.9%). Median clinical follow-up duration after submaximal angioplasty was 19 months, with ≥1 year of follow-up available for 32 patients. One-year perioperative and ischemic event-free survival was high (29 of 32 patients, 91%). CONCLUSION: In this series, periprocedural safety of submaximal angioplasty in the setting of acute, symptomatic atherosclerotic intracranial stenosis was demonstrated. Although direct comparison is impossible because many patients were ineligible for stenting procedures, the complication profile compares favorably with rates of identically defined event-free survival for patients randomized to the medical (88%) and surgical (77%) arms of SAMMPRIS despite the absence of aggressive medical management. Copyright © 2012 by the Congress of Neurological Surgeons.

Dumont T.M.,University at Buffalo Neurosurgery | Dumont T.M.,Gates Vascular Institute | Eller J.L.,University at Buffalo Neurosurgery | Eller J.L.,Gates Vascular Institute | And 7 more authors.
Neurosurgery | Year: 2014

Recent advancements in all phases of endovascular aneurysm treatment, including medical therapy, diagnostics, devices, and implants, abound. Advancements in endovascular technologies and techniques have enabled treatment of a wide variety of intracranial aneurysms. In this article, technical advances in endovascular treatment of cerebral aneurysms are discussed, with an effort to incorporate a clinically relevant perspective. Advancements in diagnostic tools, medical therapy, and implants are reviewed and discussed. Copyright © 2014 by the Congress of Neurological Surgeons.

Nanda A.,Louisiana State University Health Sciences Center | Thakur J.D.,Louisiana State University Health Sciences Center | Sonig A.,Gates Vascular Institute | Missios S.,Louisiana State University Health Sciences Center
Journal of Neurosurgery | Year: 2016

OBJECTIVE: Cavernous sinus meningiomas (CSMs) represent a cohort of challenging skull base tumors. Proper management requires achieving a balance between optimal resection, restoration of cranial nerve (CN) function, and maintaining or improving quality of life. The objective of this study was to assess the pre-, intra-, and postoperative factors related to clinical and neurological outcomes, morbidity, mortality, and tumor control in patients with CSM. METHODS: A retrospective review of a single surgeon's experience with microsurgical removal of CSM in 65 patients between January 1996 and August 2013 was done. Sekhar's classification, modified Kobayashi grading, and the Karnofsky Performance Scale were used to define tumor extension, tumor removal, and clinical outcomes, respectively. RESULTS: Preoperative CN dysfunction was evident in 64.6% of patients. CN II deficits were most common. The greatest improvement was seen for CN V deficits, whereas CN II and CN IV deficits showed the smallest degree of recovery. Complete resection was achieved in 41.5% of cases and was not significantly associated with functional CN recovery. Internal carotid artery encasement significantly limited the complete microscopic resection of CSM (p < 0.0001). Overall, 18.5% of patients showed symptomatic recurrence after their initial surgery (mean follow-up 60.8 months [range 3-199 months]). The use of adjuvant stereotactic radiosurgery (SRS) after microsurgery independently decreased the recurrence rate (p = 0.009; OR 0.036; 95% CI 0.003-0.430). CONCLUSIONS: Modified Kobayashi tumor resection (Grades I-IIIB) was possible in 41.5% of patients. CN recovery and tumor control were independent of extent of tumor removal. The combination of resection and adjuvant SRS can achieve excellent tumor control. Furthermore, the use of adjuvant SRS independently decreases the recurrence rates of CSM. ©AANS, 2016.

Mokin M.,State University of New York at Buffalo | Mokin M.,Gates Vascular Institute | Levy E.I.,State University of New York at Buffalo | Levy E.I.,Gates Vascular Institute | And 4 more authors.
Journal of Neuroimaging | Year: 2014

BACKGROUND AND PURPOSE: Early recognition of complications during intracranial neuroendovascular interventions is important for medical decision making and prompts administration of life-saving treatments. Low contrast imaging (LCI) provides computed tomographic (CT)-like images of anatomical brain structures, capable of detecting hydrocephalus and intracranial hemorrhage complications. We present our early experience with LCI using the Toshiba Infinix-i biplane angiographic suite during neurointerventional cases, including acute stroke interventions, aneurysm embolization, and subarachnoid hemorrhage management. METHODS: Six patients underwent LCI during various neuroendovascular procedures. We describe clinical and imaging findings and provide visual comparison of LCI with conventional noncontrast cranial CT imaging. RESULTS: Our initial experience shows that LCI is capable of detecting or excluding intracerebral hemorrhage and hydrocephalus during neurointerventional procedures as well as confirming ventriculostomy catheter placement when compared to noncontrast CT imaging. Motion artifact is a major limitation associated with this technology and can be overcome in part by performing shorter duration rotation sequences. CONCLUSIONS: LCI is a promising tool in the arsenal of a neuroendovascular interventionist, especially when a complication is suspected during an intervention, potentially obviating the need for immediate transfer of the patient to a conventional CT scanner. Further studies comparing LCI with conventional noncontrast CT imaging are necessary. © 2014 by the American Society of Neuroimaging.

PubMed | State University of New York at Buffalo and Gates Vascular Institute
Type: | Journal: Medical devices (Auckland, N.Z.) | Year: 2014

Carotid artery stenting technologies are rapidly evolving. Options for endovascular surgeons and interventionists who treat occlusive carotid disease continue to expand. We here present an update and overview of carotid stenting devices. Evidence supporting carotid stenting includes randomized controlled trials that compare endovascular stenting to open surgical endarterectomy. Carotid technologies addressed include the carotid stents themselves as well as adjunct neuroprotective devices. Aspects of stent technology include bare-metal versus covered stents, stent tapering, and free-cell area. Drug-eluting and cutting balloon indications are described. Embolization protection options and new direct carotid access strategies are reviewed. Adjunct technologies, such as intravascular ultrasound imaging and risk stratification algorithms, are discussed. Bare-metal and covered stents provide unique advantages and disadvantages. Stent tapering may allow for a more fitted contour to the caliber decrement between the common carotid and internal carotid arteries but also introduces new technical challenges. Studies regarding free-cell area are conflicting with respect to benefits and associated risk; clinical relevance of associated adverse effects associated with either type is unclear. Embolization protection strategies include distal filter protection and flow reversal. Though flow reversal was initially met with some skepticism, it has gained wider acceptance and may provide the advantage of not crossing the carotid lesion before protection is established. New direct carotid access techniques address difficult anatomy and incorporate sophisticated flow-reversal embolization protection techniques. Carotid stenting is a new and exciting field with rapidly advancing technologies. Embolization protection, low-risk deployment, and lesion assessment and stratification are active areas of research. Ample room remains for further innovations and developments.

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