Stroke

The Boston Medical Center is a Comprehensive Stroke Center certified by The Joint Commission. The Joint Commission monitors and certifies performance to the high standards in all areas of stroke care.

The Boston Medical Center Stroke Division is a member of the New England Regional Coordinating Center (NERCC) for the National Institute of Neurological Disorders and Stroke (NINDS), a consortium designed to implement clinical trials.  Clinical trials play a critical roles in the advancement of neurologic therapies.  BMC offers an opportunity for patients from many backgrounds to enroll in trials testing new treatments.

Current Clinical Trials and Cohort Studies
  • ARCADIA
    • Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke
    • Sponsor: National Institute of Neurological Disorders and Stroke (NINDS)
    • Question: Is aspirin or apixaban more effective for recurrent stroke prevention in patients with high-risk embolic stroke of undetermined source?
  • ASPIRE
    • Anticoagulation in ICH Survivors for Stroke Prevention and Recovery
    • Sponsor: NINDS
    • Question: Is aspirin or apixaban more effective for recurrent strkoke prevention for patients with recent intracerebral hemorrhage and high-risk atrial fibrillation?
  • Sleep SMART
    • Sleep for Stroke Management and Recovery Trial
    • Sponsor: NINDS
    • Question: Will early implementation of positive airway pressure (CPAP) reduce recurrent stroke and other cardiovascular events and improve outcomes in patients after a recent stroke or high-risk transient ischemic attack?
  • DISCOVERY –
    • Determinants of Incident Stroke Cognitive Outcomes and Vascular Effects on Recovery
    • Sponsor: NINDS and National Institute on Aging (NIA)
    • Questions: How do pre-existing vascular and neurodegenerative disease and stroke type and genetic and epigenetic variation affect cognitive disability and overall post-stroke recovery?
Investigator-initiated Research
  • Framingham Heart Study
    • The Framingham Heart Study was launched in 1948 to follow a large cohort of patients with the goal of identifying risk factors for cardiovascular and cerebrovascular disease. This now multigenerational study continues to contribute to the understanding of the epidemiology of stroke and heart disease. A major focus of the BMC Neurology group is the interaction of stroke with degenerative neurologic disease, such as Alzheimer’s disease, and the contribution of vascular disease to late-life and early-onset dementia.
  • Black Women’s Health Study
    • The Black Women’s Health Study was launched in 1995 to follow a large cohort of black women, who as a group suffer from high rates of many disease and are underrepresented in many women’s health studies. BMC Stroke Neurology contributes to the investigations of cerebrovascular disease and dementia by this group.
  • Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS NeuroCOVID Study)
    • This global consortium study seeks to describe the neurologcic manifestations and outcomes in patient infected with the SARS-CoV-2 virus that causes COVID-19.
  • The Infective Endocarditis Working Group
    • This collaborative group comprising BMC Neurology, Cardiology, Cardiovascular Surgery, Infectious Diseases, and Psychiatry studies infective endocarditis seeking to determine the best approaches to evaluation and management.

Massachusetts American Heart Association/American Stroke Association Working Groups

The BMC Stroke Division plays a leadership role in the efforts of the AHA/ASA to organize all stroke centers in Massachusetts and many center across New England in the education of the population around stroke prevention, stroke symptoms and response, and the development of efficient stroke systems of care for our communities.

Team Members
Grants and Contracts
  • 19-24 Enlarged perivascular spaces as markers of vascular and Alzheimer pathology: predictors, pathophysiology, and clinical consequences; NIH/NIA R01; PI: Rafael Romero, MD
  • 18-23 Genetic contribution to brain arterial dilatation and its role in cognition and dementia; NIH/NINDS R01; PI Gutierrez Contreras; BMC PI: Rafael Romero, MD
  • New England Regional Coordinating Center for NINDS Stroke Trials Network (NERCC); NIH/NINDS; PI: Steven Feske, MD
  • Novel biomarkers to predict cognitive decline and dementia in persons with cerebrovascular disease; AAN Career Development Award; PI: Hugo Aparicio, MD, MPH
  • Blood biomarkers for prediction of vascular cognitive impairment & dementia; Alzheimer’s Association Award; PI: Hugo Aparicio, MD, MPH
  • Pregnancy complications in relation to stroke risk in African American women; NIMHD R01; PI Shanshan Sheehy; Co-investigator: Hugo Aparicio, MD, MPH
  • Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke (ARCADIA); NINDS: BMC site-PI: Julie Shulman, MD
  • Anticoagulation in ICH Survivors for Stroke Prevention and Recovery (ASPIRE); NINDS; BMC site-PI: Steven Feske, MD
  • Sleep for Stroke Management and Recovery Trial (Sleep SMART); NINDS; BMC site-PIs: Naina Limbekar, MD and Rafael Romero, MD
  • Determinants of Incident Stroke Cognitive Outcomes and Vascular Effects on Recover (DISCOVERY); NINDS and NIA; site-PIs: Hugo Aparicio and Steven Feske, MD
Unfunded projects
  • BMC Stroke QI and Research Database; PI: Steven Feske, MD
  • Neurologic Complications of Infective Endocarditis: PIs: Anna Cervantes-Arslanian, MD and Steven Feske, MD
Selected Publications: Peer Reviewed Research and Major Guidelines

Baril AA, Beiser AS, Mysliwiec V, Sanchez E, DeCarli CS, Redline S, Gottlieb DJ, Maillard P, Romero JR, Satizabal CL, Zucker JM, Seshadri S, Pase MP, Himali JJ. Slow-Wave Sleep and MRI Markers of Brain Aging in a Community-Based Sample. Neurology. 2021 Mar 9;96(10):e1462-e1469.

Romero JR, Himali JJ, Beiser A, Pase MP, Davis-Plourde KL, Parva P, Seshadri S, Mitchell GF. Aortic stiffness and cerebral microbleeds: The Framingham Heart Study. Vasc Med. 2021 Jan

Virani SS, Alonso A, Aparicio HJ … VanWagner LB, Wang NY, Tsao CW; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021 Jan 27

Sreekrishnan A, Ong CJ, Mahajan R, Prescott B, Smirnakis SM, Bevers MB, Feske SK, Snider SB. Subcortical sparing associated with ambulatory independence after hemicraniectomy for malignant infarction. J Stroke Cerebrovasc Dis 2021;30(8):105850.

Ramos-Araque ME, Siegler JE, Ribo M, Requena M, López C, de Lera M, Arenillas JF, Pérez IH, Gómez-Vicente B, Talavera B, Portela PC, Guillen AN, Urra X, Llull L, Renú A, Nguyen TN, Jillella D, Nahab F, Nogueira R, Haussen D, Then R, Thon JM, Esparragoza LR, Hernández-Pérez M, Bustamante A, Mansour OY, Megahed M, Hassan T, Liebeskind DS, Hassan A, Bushnaq S, Osman M, Vazquez AR; SVIN Multinational Registry and Task Force. Stroke etiologies in patients with COVID-19: the SVIN COVID-19 multinational registry. BMC Neurol. 2021 Jan 30;21(1):43.

Shulman JG, Qureshi MM, Lau H, Finn B, Abbas S, Cervantes A, Mercado M, Greer D, Jara H, Chapman M, Mian A, Takahashi C. Perihematomal Edema Surrounding Spontaneous Intracerebral Hemorrhage by CT: Ellipsoidal vs. Morphometric Volumetry. Medicine. 2020 Jul 10;99(28):e20951

Leslie-Mazwi T, Fargen KM, Levitt M, Derdeyn CP, Feske SK, Patel AB, Hirsch JA. Preserving access: a review of stroke thrombectomy during the COVID-19 pandemic.  Am J Neuroradiol (AJNR) 2020;

Cervantes A, Lau V, Anand P, Shulman JG, Ford T, Takahashi C, Daneshmand A, Nguyen T, Suchdev K, Abdennadher M, Saxena A, Macone A, Perloff M, Zhu S, Greer D. Rapid Dissemination of Clinical Knowledge in a Pandemic: Our Experience Developing and Disseminating Protocols for Managing Inpatients with Neurological Diseases and COVID-19. Ann Neurol. 2020 Aug;88(2):211-214

Sharma R, Zachrison KS, Viswanathan A, Matiello M, Estrada J, Anderson C, Etherton M, Silverman S, Rost N, Feske SK, Schwamm LH.  Trends in telestroke care delivery: A 15-year experience of an academic hub and its network of spokes.  Circulation: Cardiovascular Quality and Outcomes 2020;13(3):e005903

Ford T, Curiale G, Nguyen T, Aparicio H, Hamlyn E, Gangadhara S, Cervantes A, Greer D, Romero JR, Shulman JG. Optimization of Resources and Modifications in Acute Ischemic Stroke Care in Response to the Global COVID-19 Pandemic. J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104980

Romero JR, Demissie S, Beiser A, Himali JJ, DeCarli C, Levy D, Seshadri S. Relation of plasma β-amyloid, clusterin, and tau with cerebral microbleeds: Framingham Heart Study. Ann Clin Transl Neurol. 2020 Jun 26.

Aparicio HJ, Himali JJ, Satizabal CL, Pase MP, Romero JR, Kase CS, Beiser AS, Seshadri S, Temporal trends in ischemic stroke incidence in younger adults in the Framingham Study. Stroke 2019;50:1558-1560.

Sheriff F, Diz-Lopes M, Khawaja A, Sorond FA, Tan O, Azevedo E, Franceschini MA, Vaitkevicius H, Li K, Monk AD, Michaud SL, Feske SK, Castro P. Microemboli after successful thrombectomy do not affect outcome but predict new embolic events. Stroke 2019;51(1):154-161.

Aparicio HJ, Petrea RE, Massaro JM, Manning WJ, Oyama-Manabe N, Beiser, Seshadri S. Temporal Trends in Ischemic Stroke Incidence in Younger Adults in the Framingham Study. Stroke. 2019;50:1558-1560.

Dhand A, Luke DA, Lang CE, Tsiaklides M, Feske S, Lee JM. Social networks and risk of delayed hospital arrival after acute stroke. Nature Communications 2019;10:1206. PMCID: PMC6418151

Izzy S, Rubin D, Ahmed F, Renault S, Sylvester K, Vaitkevicius H, Smallwood J, Givertz M, Feske SK. Cerebrovascular accidents during mechanical circulatory support: New predictors of ischemic and hemorrhagic stroke and outcomes. Stroke 2018;49: 1197-1203

Aparicio HJ, Petrea RE, Massaro JM, Manning WJ, Oyama-Manabe N, Beiser AS, Kase CS, D’Agostino RB, Wolf PA, Vasan RS, DeCarli C, O’Donnell CJ, Seshadri S. Association of descending thoracic aortic plaque with brain atrophy and white matter hyperintensities: The Framingham Heart Study. 2017; 265:305-311.

Romero JR, Preis SR, Beiser A, Himali JJ, Shoamanesh A, Wolf PA, Kase CS, Vasan RS, DeCarli C, Seshadri S. Cerebral Microbleeds as Predictors of Mortality: The Framingham Heart Study. Stroke. 2017 Mar;48(3):781-783. doi:10.1161/STROKEAHA.116.015354. Erratum in: Stroke. 2017 Mar;48(3):e98.

Aparicio HJ, Himali JJ, Beiser AS, Davis-Plourde KL, Vasan RS, Kase CS, Wolf P and Seshadri S. “Overweight, Obesity, and Survival after Stroke in the Framingham Heart Study.” Journal of the American Heart Association. 2017;6.

Romero JR, Beiser A, Himali JJ, Shoamanesh A, DeCarli A, Seshadri S. Cerebral Microbleeds and risk of Incident Dementia: The Framingham Heart Study. Neurobiology of Aging (2017).

Chapters, Reviews, Editorials, etc.

Feske SK. Ischemic stroke. American Journal of Medicine December 2021; published online August 27, 2021.

Greer DM, Aparicio HJ, Siddiqi OK, Furie KL. “Cardiac Diseases.” In: Stroke: Pathophysiology, Diagnosis, and Management, 7th Grotta J, Albers G, Broderick J, Kasner S, Lo E, Sacco R Wong L, Day A, eds. Elsevier 2021.

Lazar RM, Howard VJ, Kernan WN, Aparicio HJ, Levine DA, Viera AJ, Jordan LC, Nyenhuis DL, Possin KL, Sorond FA, White CL; American Heart Association Stroke Council. A Primary Care Agenda for Brain Health: A Scientific Statement From the American Heart Association. Stroke. 2021 Mar 15

Shulman JG, Ford T, Cervantes-Arslanian A. Neurologic Emergencies during the Coronavirus Disease 2019 Pandemic. Neurologic Clinics. , March 26, 2021

Feske SK. Ischemic stroke in the neurocritical care unit.  In: Neurointensive Care Unit: Clinical Practice and Organization. (Sarah E. Nelson and Paul A. Nyquist, eds.) Cham, Switzerland: Humana Press: 2020, pp.109-120.

Camargo EC, Feske SK, Singhal AB. Stroke in Pregnancy. Neurologic Clinics 2019;37(1):131-48.

Hauw, J-J, Feske SK, Amarenco P, De Girolami U. Vascular pathology. In: Escourolle and Poirier’s Manual of Basic Neuropathology, 6th edition (Françoise Gray, Charles Duyckaerts, and Umberto de Girolami, eds.) Oxford: Oxford University Press; 2019, pp 82-121.

Aparicio HJ. Stroke Research with Longitudinal Cohort Studies. Stroke. 2019;50:e103-e105. PMID: 30841822.

Shulman JG, Cervantes-Arslanian A. Infectious Etiologies of Stroke. Seminars in Neurology. Aug;39(4):482-494. 2019.

Smith EE, Romero JR. Mixed emotions: What to do with patients who have lobar and deep hemorrhages on MRI? Neurology. 2018 Jan 9;90(2):55-56. doi:10.1212/WNL.0000000000004811. Epub 2017 Dec 15.

Feske SK (ed). Women’s Issues in Neurology. Seminars in Neurology 2017 December;73(6).

Sells CM, Feske SK. Stroke in Pregnancy. Seminars in Neurology 2017;37:669-78.

Duque C, Feske SK, Sorond FA. Cerebrovascular hemodynamics in women. Seminars in Neurology 2017;37:679-88.