Robert M Starke MD., MSc.

Great work by STAR team. Many areas to improve how we are doing thrombectomy. I would support this trial. Thanks for including us. It's time to the aspiration procedure. With improved devices & research

Looking forward to it. Thanks for supporting residents, fellows, and attendings with these educational seminars!

Thanks so much for having me as visiting professor to the joint joint grand rounds and symposium. Amazing to learn from the team. Best part is seeing former residents & fellows succeeding in every area. Wonderful meet residents who will be future leaders in the field.

Thanks so much for an excellent meeting!

Dr. Starke presenting adaptive aspiriation at

Thanks so much for an excellent meeting!

‪Dr. Robert Starke ‬ shares results of D5W “sugar push” technique for MMA embolization using NBCA.

Very excited for this event with actor & comedian TJ Miller (Deadpool, Office Christmas Party, Silicon Valley, Emoji Movie, so many more) to discuss his brain journey. Although we have treated many celebrities & patients, they often see this as a stigma & don't want to come forward. I completely understand this point of view as it is a challenging and often long personal journey. It takes a lot of courage to discuss one's experience in an effort to help future patients. I think this will be a entertaining and wonderful event.

COMPLETE CLOT INGESTION ( ). Looking forward to presenting on CCI in the late breaking abstract session at national meeting in collaboration with & . We test a lot of new devices in the laboratory. Recently we compared new pump by which works by Adaptive Pulsatile Aspiration ( ) to static aspiration. APA resulted in better CCI, fewer distal emboli, and faster reperfusion. It's time to the aspiration procedure. With improved devices & research

www.snisonline.org

MASSIVE DURAL SINUS MALFORMAION IN NEWBORN. Baby born with hydrocephalus (fluid build up causing brain compression), heart failure, lung failure. Rarest variant of Vein Galen Arteriovenous Malformations when there can be high flow arterial to venous shunt(s).

Stage 1 endovascular therapy performed through umbilical artery (belly button) to close shunt 1 in the brain when baby 2.7 kg (95% closed). Baby out of heart & lung failure and hydrocephalus improving. Stage 2 endovascular therapy performed when baby healthier via the femoral artery (leg) close final shunt 2 in brain (3 months of age).

Great to see child with no residual malformation on 5 year follow up angiogram! Used with consent.

THANKS TELEMUNDO FOR COVERING SECOND REPORTED SUCCESSFUL IN UTERO TREATMENT OF A BRAIN VEIN OF GALEN MALFORMATION (VOG). Baby found to have heart and lung failure in utero on ultrasound. This type of arterialvenous malformations (AVMs) cause brain damage, strokes, & hydrocephalus along with multi-organ failure. Usually I treat VOGs at birth by going through artery or vein in babies umbilical cord or leg to reach the brain in a minimally invasive fashion. In this case, 12 medical specialties came together for successful treatment.

Mother is awake but paralyzed for procedure from waist down. Using ultrasound intramuscular paralytic given to babies arm. Using a long needle through the mothers abdomen, we traverse the skull to access the enlarged vein in the brain and place coils to slow down the malformation.

This baby born normally with resolution of heart and lung failure. Potentially earlier treatment allows for better brain development before usual damage occurs. Currently we have research studies to collect blood and cells to better understand why babies develop these and how we can treat them better.

Interview filmed from our dedicated fetal medicine hybrid operating room.

The Aneurysm and AVM FoundationBrain aneurysm,strokes, AVM survivors and caregivers.Telemundo PRNoticias Telemundo Jackson Memorial Hospital, Miami, Florida University of Miami

Operan al bebé en el útero: madre cubana recibe milagrosa operación en el hospital Jackson El Hospital Jackson en Miami ha vuelto a hacer historia, esta vez con una inusual cirugía intrauterina realizada por primera vez en la Florida. Operaron a un...

I have bought way too many of these recently for young friends battling it out. A reminder that you got this.
•
F**k Cancer sweatshirt from . All profits from this sweatshirt will go directly to a nominated cancer fund or charity every 3 months.

First fund benefitted is The Little Piggy Fund for Amy and Paul

‘The Little Piggy Fund’ was set up in honour of our daughter India, who passed away in January 2023, aged five.

The fund raises money to directly impact families admitted to the ‘6 Tower’ Paediatric Oncology Ward at Nicklaus Children’s Hospital in Miami, Florida who took such brilliant care of us for over three years

Our hope is that this fund will not only bring smiles and laughter to the superhero children of 6 Tower, but it will also give strength and support to their awe-inspiring parents, siblings, carers and hospital staff. **kcancer

https://www.anyoldiron.us/products/any-old-iron-f**k-cancer-sweatshirt

NEW ASPIRATION TECHNOLOGY TO REMOVE BRAIN CLOTS DURING STROKE. Always great to test new technologies in the lab. APA works by a novel mechanism to remove clots & holds a lot of promise. Amazing what a group of dedicated engineers can come up with. Although cyclical aspiration tested over 10 years ago, this has not made it into clinical practise outside of ongoing trials. It’s time to the aspiration procedure. With improved Devices & research

Jackson Memorial Hospital the largest hospital in the US raising money through the community to fund major projects. A large amount of the money will be to expand the emergency department as the largest ER in the country to help more patients through a $300 million dollar project. It’s possible to make donations through

https://www.cbsnews.com/miami/video/jackson-memorial-hospital-breaks-ground-on-largest-er-expansion-in-the-country/

Major randomized clinical trial published in : ENRICH minimally invasive cerebral hematoma remova 24 hours after onset, functional outcomes better with surgery than medical treatment, particularly among patients with lobar hemorrhages. Great work & co. Thanks for including us: nej.md/3VPYggf

Recent small randomized clinical trial showed improved & outcomes with cyclical aspiration vs standard static aspiration. Data suggests that noncontinuous aspiration may be optimal. It's time to the aspiration procedure. With improved research & devices

Another paper showing improved first pass effect with fewer emboli with cyclical aspiration versus static aspiration. Still this has not been demonstrated in patients. It's time to the aspiration procedure. With improved Devices & research

Plaque removed from carotid artery. This often blocks brain blood flow or can break off and cause strokes. The rock hard nature can make thrombectomy catheters impassable and or cerebral thrombectomies difficult. It's time to the aspiration procedure. With improved research & devices

Unfortunately, many patients with successful cerebral thrombectomy for clots causing ischemic stroke still have unfavorable outcomes. This paper accepted in 2013 showed promising results for cyclical aspiration but 11 years later we are still using nearly the same static systems outside of research trials. It’s time to the aspiration procedure. With improved research & devices

Great work by et al Comparison between transradial and transfemoral mechanical thrombectomy for ICA and M1 occlusions. More insights into the optimal way to do these procedures, avenues to move the field forward, & improve patient outcomes.

https://jnis.bmj.com/content/early/2024/02/22/jnis-2023-021358

Lucky to be part of this great department. This funding is vital to helping our future patients!

Tough Father’s Day for Mr Vera who had a seizure and bleed in the brain from a rare vascular malformation and was transferred to an ICU in another country. He had various opinions from surgeons that did not feel he had a treatment option. Although we commonly perform awake brain surgery for tumors in important areas, awake brain surgery for vascularar malformations is rare. Mr Vera presented with bleeds in the brain and seizures. His vascularar malformation was next to areas of the brain controlling speech. Due to his high risk of bleeding again, surgery was the best option. During awake surgery he can talk to us through the removal of the malformation allowing us to test key speech areas for preservation. Additionally we can stimulate various areas of the brain to increase the chances of removing seizure foci alterations with the vascular malformation. Thankfully through this minimally invasive approach he was home two days later and back to his amazing family. As on of the few overall centers of excellence in the United States for the angioma alliance, allows us to bring clinicians together from many areas to improve clinical outcomes and research for u common vascular malformations. Thanks to various news stations for putting together this great story.









illustrator

Awake Brain Surgery Allows Dad to Play Another Day Robert Starke, M.D., Tenured Associate Professor of Clinical Neurosurgery and Neuroradiology at UHealth, explains how he performs a very delicate brain procedure while the patient is awake, to avoid harming critical areas of the brain such as speech. Fernando Vera is one of those patients.

3 trials of MMA embolization (EMBOLISE, MAGIC-MT, STEM) for SDH presented w impressive results summarized below. Minimally invasive treatment of subdural hemorrhage will be new standard of care. Thankful for opportunity to participate.

I didn’t become interested in research to almost the end of my third year of medical school when it had clinical relevance. I was with out the skills so I took two years off from medical school to do a masters degree in the NIH clinical research training program while doing basic science, translational, and clinical research. It was a large time and financial investment, but these skills are helpful for me now on a daily basis. The number of publications is irrelevant, but highlights that I have been lucky to be surrounded by great scientists and clinicians. My research laboratory team now focuses on novel diagnostic tests, medical therapies, imaging, and minimally invasive treatment strategies for Neurovascular diseases and tumors. My clinical research team focuses on trials and improving outcomes. If we are treating our patients the same way in the next 5, 10, 20, 50 years, we have done the next generation of patients a huge disservice. Many thanks to the NIH, Department of Health, BEE Foundation, The Aneurysm AVM Foundation, Brain Aneurysm Research Foundation, Joe Niekro Foundation, NREF, and all the companies and patients that have helped support our research!

Great Technical Video Combined venous and arterial access in the arm for treatment of a complex dural arteriovenous fistula

Combined venous and arterial access in the arm for treatment of a complex dural arteriovenous fistula: a technical video Transvenous access is a necessary tool for numerous cerebrovascular pathologies. Transvenous access in the arm offers several benefits compared with transfemoral access, including patient comfort, the avoidance of transfemoral access complications, and the ability to close both radial arterial acces...

Dural arteriovenous fistulas (DAVF) can cause significant venous congestion resulting in brain swelling, neurological alterations, seizures. The abnormal dilated veins seen in this intraoperative image of a high grade DAVF are prone to bleeding. DAVF occur in 1 in 10,000,000 people but this is a disease we see daily. Although most DAVF are treated endovascularly, radiosurgery or microsurgery are sometimes better options. DAVF of the sphenoid wing / orbital fissure are some of the rarest (1 in 100,000,000) and usually require surgery due to intimate relationship to arteries that supply vision. Fortunately this is a straight forward surgery via a skull base approach. This patient was treated with a craniotomy for surgical ligation and made an excellent recovery.

Results from this trial coming shortly.

Strong work by the STAR group. The effect of the golden hour (1 hour post access) is reproducible across subgroups. After 1 hour, there is increased risk for worse clinical outcomes & hemorrhage. Thanks for including us. Link: https://bit.ly/3QhEUfG

Thanks to all the organizations highlighting Workd Stroke day. We all appreciate you supporting our patients, their families, and our research. Together we can all do better.