UC experts present neurology research at national conference

Sometimes called a “brain tsunami,” a spreading depolarization (SD) is an event where brain cells lose their charge, become depolarized and are unable to send electrical signals to one another. SDs often occur following a traumatic brain injury and are associated with worse outcomes, but using this information to treat patients has not been previously tested.

A team led by UC’s Jed Hartings, PhD, Laura Ngwenya, MD, and Brandon Foreman, MD, are conducting the INDICT trial, the first Phase 2 trial to test the feasibility of treating patients based on diagnosing SDs in real time.

“We are trying to determine whether we can integrate information about spreading depolarizations into decision-making and treatment of severe traumatic brain injury,” said Hartings, professor and vice chair of research in the Department of Neurosurgery in UC’s College of Medicine. “In other words, can we use the information and methods developed in research on SDs and implement it for possible patient benefit in clinical care?”

Since 2023, researchers at UC, the University of California San Francisco and University of Pennsylvania have enrolled 31 patients in the trial.      

“We have found that SDs can be diagnosed in real time, and that this information can be used to guide adjustments in clinical care,” Hartings said of early results from the trial. “Specifically, we have found that diagnosis and treatment result in a more than 50% reduction in the number of SDs that patients experience.”  

As the trial moves forward, Hartings said an important step will be to determine whether identifying and treating SDs can result in long-term improved patient outcomes.

Hartings will present “Feasibility Trial of Spreading Depolarization Monitoring to Guide Management of Severe Traumatic Brain Injury: Initial Results.”

For some strokes, the best treatment is a thrombectomy, where doctors mechanically remove a blood clot in an artery to restore blood flow to the brain. 

To accomplish this and some other neurovascular interventions, neurointerventionalists must precisely manipulate and navigate a guidewire through the blood vessels. Current guidewires are manipulated by the interventionalist from the groin or wrist with the tip of the wire within the blood vessels of the brain. Limited guidewire control can make procedures longer and increase the risk of complications. 

Researchers from the Massachusetts Institute of Technology, Harvard Medical School and the University of Cincinnati, including first author Pablo Harker, MD, compared a novel magnetic robotic guidewire navigation system to conventional manual navigation. Using three anatomical models of increasing difficulty, four operators with varied levels of clinical experience performed a total of 72 procedures.

“We wanted to know if our novel magnetically steered, robotic system for navigating within the blood vessels of the brain improved the time it takes to access the target vessel,” said Harker, a fellow in UC’s Department of Neurology and Rehabilitation Medicine. “It reduces access times by a factor of 10 times and makes it so that there's a significantly smaller gap between experienced and junior interventionalists. This will result in shorter and safer procedures for patients requiring complex neurovascular interventions.”

Moving forward, the team plans to further develop the system and begin preclinical, “first-in-human” testing.

This research was financed by Magnendo Corp., a spinoff from the Department of Mechanical Engineering at MIT in collaboration with the Department of Neurosurgery at Massachusetts General Hospital/Harvard Medical School. Harker serves as a scientific advisor for Magnendo.

Harker will present “Closing the Experience Gap: Magnetic Robotic Navigation Enables Consistent Guidewire Performance Across Operators.”