Putting surgeons, researchers together is leading to world-class innovations
By GROVE POTTER
Published May 18, 2017
L. Nelson “Nick” Hopkins is a pioneer in the use of catheters — long, flexible tubes — inserted into the vascular system in the groin and threaded to the brain to treat strokes. The procedure, once called “crazy” by the medical establishment, is now the preferred method in many situations.
His early use of endovascular surgery led Hopkins, SUNY Distinguished Professor in the Department of Neurosurgery, and a neurosurgeon with UB Neurosurgery, to confer with other types of surgeons — cardiologists, vascular surgeons and radiologists — who were using the technique. The cross-referencing broadened Hopkins’ appreciation for coming at a problem from different angles.
That cooperative approach is the driving force behind numerous research efforts now underway at a facility on the burgeoning Buffalo Niagara Medical Campus. The building is a partnership between UB and Kaleida Health that Hopkins helped usher into existence. The 10-story building houses Kaleida’s Gates Vascular Institute, dedicated to patient care, of which Hopkins is president, and UB’s Clinical and Translational Research Center (CTRC), dedicated to translational research. The juxtaposition allows for an unprecedented level of collaboration among clinical researchers, translational scientists, surgeons and engineers.
Researchers in UB’s CTRC study problems across the entire translational spectrum, from biomarkers for sudden cardiac death and the genetic architecture of Alzheimer’s disease to depression-related asthma and new treatments for macular degeneration.
For researchers and clinicians focused on vascular disease, the collaborative environment has accelerated their ability to turn scientific innovations into advances that benefit their patients in the GVI, especially with the assistance of the industry-focused Jacobs Institute (JI), which acts as the facilitator between researchers and clinicians. Innovations have included a complete, 3D-printed model of the brain’s vascular system, new surgical techniques and new devices, including a new camera to increase visibility during endovascular procedures.
And it is garnering attention around the world. “You won’t find anything like this anywhere else on the planet,” Hopkins said in a recent interview.
As UB finishes construction of its new Jacobs School of Medicine and Biomedical Sciences building just a block from the CTRC, the pioneering work taking place within the facility serves as a model for what the university hopes to achieve when the new building is complete: advancement of new medical therapies to treat patients and creation of new opportunities to train physicians and medical students in the use of exciting new techniques.
“I think we are on the bleeding edge of innovation in neurovascular intervention. And our hope is we want to do it for all vascular surgery,” said Adnan Siddiqui, vice chair of the Department of Neurosurgery in the Jacobs School of Medicine and Biomedical Sciences and director of the Toshiba Stroke & Vascular Research Center at the CTRC. “Absolutely. Without question.”
Brain, cardiac and vascular surgeons work on the first four floors. Engineers, physicists and cell biologists work on the top floors. In between is the Jacobs Institute.
“It’s a two way street,” said Siddiqui, a neurosurgeon with UB Neurosurgery who also is director of Kaleida’s neurological stroke service and chief medical officer at the JI. “We have joint conferences; we interact with each other almost on a daily basis. We run into each other at coffee and conference and just walking in and out of the building… Not just different physician groups talking to each other, but the physicians talking to the engineers, the engineers talking to the cell biologists, the biologists talking to administrators. It’s the whole environment, the milieu that has been created.”
Chip Ionita is research assistant professor in the Department of Biomedical Engineering, a joint department formed between the Jacobs School of Medicine and Biomedical Sciences and the UB School of Engineering and Applied Sciences to facilitate these kinds of advances. As director of the Endovascular Devices and Imaging Lab at the CTRC, Ionita has created some of the world’s most advanced models of the brain’s vascular system. The models have been used again and again by physicians and medical device companies who come to Buffalo to test implantation procedures of stents and other devices to treat clots and aneurysms.
Making the full brain vascular model took time and cooperation.
The engineers had succeeded in making models of a few brain blood vessels. “Dr. Siddiqui kept pushing and pushing — ‘Can you add this? Can you add this?’ — until we got to this point where we could make a model of the brain’s vascular system,” Ionita said.
Such teamwork has led to the creation of individual models for specific cases.
Ionita made a model of one patient’s brain vasculature using a three-dimensional CT scan because Siddiqui was considering implanting a new device. Siddiqui said it helped steer the treatment.
“I was able to get the device and implant it in the model and realized it was not going to work,” Siddiqui said. “We switched the device and confirmed it was going to work and implanted that correct device in the patient.”
That individualized treatment, using modeling and, someday, personalized implements, such as catheters customized to individual patients, is a future goal, Ionita said.
For Stephen Rudin, SUNY Distinguished Professor in the Department of Radiology, the proximity of the researchers and clinicians makes true cooperation possible.
“It is so much better than when we were in different buildings miles away. The surgeons were in the old Millard Fillmore Hospital at Gates Circle, and the physics group was on the Main Street campus, and there was no interaction,” Rudin said. “Here we are in the same building, three floors away.”
Being on hand helped Rudin develop a new camera that greatly increases the imaging resolution that surgeons can see. His high-fidelity, high-resolution camera swings in front of the fluoroscopy equipment to allow greater precision without increasing the radiation dose.
Hui Meng, professor of mechanical and aerospace engineering and biomedical engineering, said the interaction with surgeons fuels her group’s research efforts.
“We feel very lucky to be working directly with doctors who are treating patients. All of our questions come from the clinical side. These are just burning questions: How do we treat these patients? How do we know whose aneurysms are dangerous so we should treat them? Which device should we use?
“We basically position ourselves just to answer the clinical questions, so we are very translational. We are applying all the most advanced tools to advance health care,” she said.
Started as a tribute
Hopkins said the genesis of the building came in 2005 when the Jacobs family spoke to him about making a tribute to the late Lawrence D. Jacobs, the renowned neurologist and multiple sclerosis researcher. Hopkins said a vascular center would be a good idea, given the prevalence of vascular disease in the Buffalo region, and Jacobs’ original work as a vascular neurologist.
After researching the idea, the Jacobs family endorsed it, organized a gathering of surgeons and sent Los Angeles architect Mehrdad Yazdani to discuss the building. After talking with the surgeons for a day, Yazdani told the group they were telling him they wanted a building that would lead to “collisions” between all the people inside. Heads nodded.
“If you look at any other major medical center in the country, all the basic disciplines are in separate areas,” Hopkins said. “Cardiology is in one area, neurosurgery is in another area, vascular surgery is in another area, and radiology is in another area.”
The Buffalo facility forces all the disciplines together.
“The other part we wanted to do, we wanted to bring together the scientists with clinicians,” continued Hopkins, who is the JI’s chief scientific officer. “So we wanted to build a science building on top of the vascular center. The original concept was to bring everyone together, anyone who works in the vascular system.”
UB has had a relationship with Toshiba since 1997, when the Japanese technology company donated $4 million in equipment. That relationship took a major step forward in 2008 when Kenichi Komatsu, president and CEO of Toshiba Medical Systems, invited Hopkins to visit.
“Over dinner, he proceeded to tell me he wanted to extend the partnership to include $20 million in imaging equipment for the entire CTRC,” Hopkins said.
The results of the teamwork and the advanced technology include inventions and technique innovations, and a growing emphasis on training. Surgeons, nurses, scientists, engineers and even marketing and medical sales people are coming from all over the world to see the facility and be trained. Teams have visited from Japan and the Netherlands, and from the Cleveland Clinic, Mount Sinai Hospital and the University of Minnesota, to name a few.
“There is no place in the world that can do what we do for training,” Hopkins said.