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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY February 2018 | Archived Issues

Affiliation of Cedars-Sinai and Torrance Memorial Official

The proposed affiliation between Cedars-Sinai and Torrance Memorial—first announced last May—became official Feb. 1. The affiliation will focus on new opportunities for coordination of care and resources between the two organizations, and joint programs to provide access to more people for needed medical services.

» Read more

Two Minutes With …

This question-and-answer feature will help you get to know some of the faculty in the Cedars-Sinai Department of Surgery. This month's installment features Mark Vrahas, MD, chair of the Department of Orthopaedics.

» Read more

$50 Million Gift Goes to Create Smidt Heart Institute

Cedars-Sinai has announced a $50 million gift from Eric and Susan Smidt and The Smidt Foundation to create the Smidt Heart Institute. The gift—the largest in Cedars-Sinai's 116-year history—will enable the hospital to expand its research and treatment of heart conditions by pursuing the most innovative science, advancing clinical trials and emerging treatments, and training the next generation of heart specialists.

» Read more

Easier, More Meaningful Advance Healthcare Directive

A new Advance Care Planning packet is available at nursing stations throughout the medical center, at outpatient clinics, and on both the Cedars-Sinai intranet and the Cedars-Sinai website. An Advance Healthcare Directive is a legal document that can be referred to in the event you are unable or don't want to participate in medical decisionmaking.

» Read more

Study Looks at Sudden Cardiac Arrest in Young People

Obesity and other common cardiovascular risk factors may play a greater role in sudden cardiac arrest among younger people than previously recognized, underscoring the importance of earlier screening, a Cedars-Sinai study has found. While sports activity often garners attention in cases of sudden cardiac arrest in younger patients, it was cited only in a small percentage of those ages 5 to 34 in the study, published in Circulation, a journal of the American Heart Association.

» Read more

Transplant Saves Bishop at the Heart of His Community

Bishop William LaRue Dillard had been plagued by fits of coughing, trembling and shortness of breath for a while, but one morning he had a particularly frightening attack and decided he couldn't ignore them any longer. He was referred to the Smidt Heart Institute, where he received a lifesaving heart transplant at age 78.

» Read more

Stop the Bleed Class Trains its 500th Student

The Department of Surgery's Trauma Program reached a milestone in their support of the National Stop the Bleed (STB) Campaign in February. Mirta Siderman, a supervisor from COACH for Kids®, was the 500th person to attend a STB course.

» Read more

Cardiac Surgery Resident Awarded Traveling Fellowship

Heidi Reich, MD, a first-year cardiac surgery resident, has been awarded the 2017 TSRA/STS Traveling Fellowship in Cardiothoracic Surgery. The $5,000 fellowship funds a one-week observership with a host institution.

» Read more

Hosting Summer Research Interns

If you would like to host a summer research intern, please notify Jesse Null, surgery and orthopaedics research manager.

» Read more

Circle of Friends Honorees for January

CoF

The Circle of Friends program honored 90 people in January. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai.

» Read more

Stenting System Benefits Certain Stroke Patients

Alexander

A specialized stenting system used to open blocked arteries in the brain resulted in a low complication rate among a specific group of patients with stroke histories, according to a study led by Cedars-Sinai researchers.

» Read more

FDA Updates Warning About Antidepressant Pristiq

The U.S. Food and Drug Administration has updated a warning about the antidepressant Pristiq (desvenlafaxine succinate) that it can lead to serotonin syndrome, a potentially life-threatening condition. The risk of suicidal thoughts and behaviors in pediatric and young adult patients is increased when used with other drugs that impair metabolism of serotonin.

» Read more

FDA Issues Warning About Incorrect Dosing of Obeticholic Acid

The U.S. Food and Drug Administration (FDA) is warning that the liver disease medicine Ocaliva (obeticholic acid) has been incorrectly dosed daily instead of weekly in patients with moderate-to-severe primary biliary cholangitis, a rare chronic liver disease. Also, in an effort to foster safe use of the over-the counter anti-diarrhea drug loperamide, the FDA is working with manufacturers to use blister packs or other single dose packaging, and to limit the number of doses in a package.

» Read more

CS-Link Tip: Refilling Prescriptions

With CS-Link™, refilling prescriptions is simple. If you want to accept prescriptions, click on the "accept all" button. If you don't have the "accept all" button on your toolbar, you also can find it under "more." Also, it's easy to move the button to your toolbar.

» Read more

Affiliation of Cedars-Sinai and Torrance Memorial Official

Torrance Memorial

The proposed affiliation between Cedars-Sinai and Torrance Memorial—first announced last May—became official Feb. 1.

The affiliation will focus on new opportunities for coordination of care and resources between the two organizations, and joint programs to provide access to more people for needed medical services—as well as access to clinical trials and the latest developments in medical research.

Among the initial areas for collaboration are advanced treatments for cancer, heart disease and brain disorders. Cedars-Sinai specialists in these areas will work with Torrance Memorial physicians to provide clinical consultations for their patients and streamline patient access to clinical trials and new technologies.

Each organization will continue to have its own board of directors, its own hospital medical staff and related physician organizations, and its own employees. Each organization's president and CEO (Craig Leach at Torrance Memorial and Thomas M. Priselac at Cedars-Sinai) will continue to lead their respective entities. Both organizations now are affiliated under a new parent organization with a new board of directors, named Cedars-Sinai Health System. Priselac will serve as president and CEO of the parent entity, Cedars-Sinai Health System, in addition to continuing to serve as president and CEO of Cedars-Sinai.

Torrance Memorial includes the 470-bed Torrance Memorial Medical Center in addition to a multispecialty physician group (Torrance Memorial Physician Network), an independent physician association (Torrance Health IPA) and an Accountable Care Organization (Torrance Memorial Integrated Physicians), which collectively include more than 500 physicians. Torrance Memorial also has several outpatient centers located throughout the South Bay region.

Cedars-Sinai includes the 886-bed Cedars-Sinai Medical Center, the 145-bed Cedars-Sinai Marina Del Rey Hospital, a multispecialty physician network of 887 doctors (Cedars-Sinai Medical Network) and many primary care, urgent care and specialty care centers throughout the Los Angeles region. It also is a major research and education center, with more than 1,600 current research projects and 500 clinical trials, and trains 473 medical residents and fellows.

"This affiliation enables each institution to continue the unique relationships each has with the communities it serves, while providing a platform for a wide variety of collaborations to better serve the region," Leach said. "As a community-based provider, Torrance Memorial will now have access to the outstanding tertiary and quaternary clinical services and research at Cedars-Sinai, which will be a great benefit to the entire South Bay."

Priselac noted the opportunities for increasing community accessibility to healthcare with the affiliation.

"While both Torrance Memorial and Cedars-Sinai have strong track records for serving the region, the governance structure of the affiliation is designed to further enhance accessibility to care and the sharing of resources to benefit patients and the community," Priselac said.

Both organizations will continue their longstanding partnerships with local community organizations aimed at improving health.

Cedars-Sinai (founded in 1902) and Torrance Memorial (founded in 1925) are two of California's longest-serving nonprofit healthcare organizations. In the past several years, they have collaborated on a variety of projects, including the establishment of a Telestroke program to more quickly diagnose and treat stroke patients.

For more information regarding the affiliation between Cedars-Sinai and Torrance Memorial, view the Frequently Asked Questions.

Affiliation FAQs (PDF)  

Two Minutes With …

This question-and-answer feature will help you get to know some of the faculty in the Cedars-Sinai Department of Surgery.

Mark Vrahas, MD

Mark Vrahas, MD, chair of the Department of Orthopaedics

Where did you grow up?

I grew up in Dubois, Pennsylvania, which is a very small town about 100 miles northeast of Pittsburgh. My family was in the restaurant business, and we owned two restaurants and a bakery. One of the restaurants was a hot dog shop with hot dogs much better than Pink's. We sold hot dog sauce in all the major grocery chains in western Pennsylvania and New York.

Why did you decide to specialize in orthopaedic surgery?

I came to orthopaedics through biomechanics research. In the summer of my second year of medical school in Pittsburgh, I was walking by a lab where they were smashing bones in a mechanical testing machine. It looked like so much fun that I ask the lab director if I could join the research effort. With that first exposure to orthopaedics and orthopaedic surgeons, I was hooked.

If you were not a physician, what career would you choose?

I would be a world cup skier or professional golfer. But since I am not very good at either of those things, I guess I would have to fall back on the family business as a restaurateur.

Outside the operating room, where do you find inspiration?

I find it in the mountains, fishing, skiing or hiking. I love the wisdom of the old mountains in the east and the drama of the Rockies.

What is the funniest thing a patient has ever said to you?

I really can't recall anything that we could actually publish.

Is there something or someplace you have never seen that you would like to see in the near future?

Alaska.

$50 Million Gift Goes to Create Smidt Heart Institute

Eric and Susan Smidt and The Smidt Foundation made a $50 million gift to create the Smidt Heart Institute.

Cedars-Sinai has announced a $50 million gift from Eric and Susan Smidt and The Smidt Foundation to create the Smidt Heart Institute. The gift will advance vital research and innovative practices across the fields of cardiology and cardiovascular surgery.

The gift—the largest in Cedars-Sinai's 116-year history—will enable the hospital to expand its research and treatment of heart conditions by pursuing the most innovative science, advancing clinical trials and emerging treatments, and training the next generation of heart specialists.

"Eric and Susan Smidt approached Cedars-Sinai with the desire to contribute a transformative and inspiring gift that will improve lives both here in Los Angeles and around the world," said Thomas M. Priselac, president and CEO. "The Smidt Heart Institute will propel us forward in leading the quest for innovation with the goal of devising better treatments for heart disease, one of the world's greatest health needs."

Heart disease is the leading cause of death in Los Angeles County, across the U.S. and globally. More than 92 million Americans live with cardiovascular diseases, including heart attack, stroke and high blood pressure, and about 2,200 die each day from these conditions.

As the top cardiology and heart surgery center in the western U.S., the Smidt Heart Institute brings together 16 centers and programs with specialization in transplantation, stem cell therapy, congenital heart disease, women's heart health, valve disorders, arrhythmia and hypertension. More than 100 doctors at the Smidt Heart Institute are pursuing the most advanced cardiac research, such as using stem cells to regrow heart tissue after a heart attack, while treating patients with some of the world's leading heart techniques, such as using 3-D printing to help physicians perform minimally invasive heart valve repair and replacement for children with congenital heart defects.

"We are deeply moved by the opportunity to support our family's local medical center and also serve the global medical community by funding Cedars-Sinai's internationally renowned heart research," said Eric Smidt, who is the founder, owner and CEO of the national retailer Harbor Freight Tools, based in Calabasas, Calif. "Cedars-Sinai cardiologists are pioneers in this field, and the heart institute is one of the world leaders when it comes to modern heart medicine—and it's in our own backyard. It's important to support outstanding local institutions, and we want to help amplify Cedars-Sinai's impact on human health and wellbeing here and far beyond Los Angeles. We are humbled to play a role in their long tradition of saving lives and serving our community."

The gift to Cedars-Sinai is the couple's largest to date. The Smidt Foundation supports organizations dedicated to excellence in education, medical research, the arts, veterans' affairs, disaster relief and first responders. The couple funded The Alliance Susan and Eric Smidt Technology High, a charter school in Los Angeles, and they are long-time supporters of the Los Angeles County Museum of Art. Eric Smidt created and funds Harbor Freight Tools for Schools to support the advancement of skilled trades education in U.S. public high schools. The program funds the annual Harbor Freight Tools for Schools Prize for Teaching Excellence, which in 2017 awarded more than $500,000 to outstanding skilled trades teachers and public high school programs across the U.S.

"This extraordinary gift is heartfelt in every way and stands as a wonderful testament to the enduring impact of our globally respected heart institute on the lives of so many patients," said Shlomo Melmed, MD, executive vice president of Academic Affairs and dean of the medical faculty. "This generous gift is the most admirable recognition of our talented physicians and scientists who have dedicated themselves to creating one of the world's leading institutes of cardiac clinical care and creative scholarly achievement."

Eduardo Marbán, MD, PhD, director of the Smidt Heart Institute, said the gift ensures Cedars-Sinai will continue its tradition of innovation and discovery, which dates back to 1924 when Los Angeles' first electrocardiogram machine was installed.

"Eric and Susan Smidt's generous gift will have an enormously positive impact on our ability to provide the best cardiac care possible to our patients," Marbán said. "We are deeply grateful for their visionary support, which will cement the reputation of the Smidt Heart Institute as the leading resource for all aspects of cardiology and cardiovascular surgery."

Added Marc H. Rapaport, chair of the Board of Directors: "The future of heart care is here. The Smidts have ensured that Cedars-Sinai will continue to have a positive impact on the health of our community and beyond."

Easier, More Meaningful Advance Healthcare Directive

"What makes my life worth living?"

A new Cedars-Sinai Advance Healthcare Directive was designed to spark this type of soul-searching.

"We want this directive to make people think about what's important to them, what quality of life they would be willing to accept and what they most value," said Bradley Rosen, MD, vice president of Physician Alignment and Care Transitions and co-leader of the Quality Council's Advance Directive Redesign Working Group. "These aren't yes-or-no questions. You have to dig deeper."

An Advance Healthcare Directive is a legal document that can be referred to in the event you are unable or don't want to participate in medical decisionmaking. In the directive, you can name someone who can make medical decisions on your behalf. You also can state any goals, values and preferences concerning your healthcare.

The Advance Directive Redesign Working Group—a multidisciplinary team with members from Chaplaincy, Communications, Healthcare Ethics, Nursing, Performance Improvement, Pharmacy Services, Primary Care, Risk Management and Supportive Care Medicine—was charged with improving the directive that's been used at Cedars-Sinai for the past several years. Patient and clinician feedback indicated the document should be shorter and less confusing. The working group also felt the directive should allow patients an opportunity to provide more meaningful information about themselves.

"We wanted a document that would enable us to really know who you are as a person and what matters to you," said Stuart Finder, PhD, director of the Center for Healthcare Ethics and member of the Advance Directive Redesign Working Group.

Achieving that goal proved challenging.

"The process was intense," said Rosen. "Over the course of a year, we went through at least 30 drafts, engaged in multiple brainstorming sessions, elicited feedback from 12 specialty areas and several hospital committees, and made substantive changes every step of the way." 

That intense process culminated in a newly printed Advance Care Planning packet that's available at nursing stations throughout the medical center, at outpatient clinics, and on both the Cedars-Sinai intranet and the Cedars-Sinai website.

The packet comes in a folder containing the Advance Healthcare Directive and a step-by-step guide that walks users through the entire directive. There are optional sections on topics such as organ donation and funeral arrangements. Worksheets also are included so users can indicate what quality of life they're willing to accept.

"I really like what we created. It provides so much more useful information to help us better know who we're taking care of, and to ensure the care we provide is fitting for them as a person," said Finder.

Rosen agrees. "The new packet is nicely organized and much easier to navigate. The contents represent a significant step forward to educate people about the purpose of an Advance Healthcare Directive and to elicit more meaningful, actionable information," said Rosen.

The folder also includes a flyer for Cedars-Sinai's free Advance Care Planning classes, offered twice a month to the public, Cedars-Sinai employees, patients and families. The classes are taught by licensed clinical social workers who explain the purpose of an Advance Healthcare Directive, orient people to the new packet and offer attendees assistance in completing their own directives.

The days and times of the class are:

  • The fourth Tuesday of each month, from 10 a.m.-noon at 8501 Wilshire Blvd., Suite 340.
  • The fourth Tuesday of each month, from 6:30-8:30 p.m. in the Advanced Health Sciences Pavilion, PEC Room 4.

To sign up for the class, call 800-700-6424.

Jaime Goldberg, LCSW, a clinical social worker with Supportive Care Medicine, teaches the Tuesday evening class and was an active member of the redesign team.

"I always emphasize that, as the name suggests, an Advance Healthcare Directive should be completed before any illness or injury occurs," said Goldberg. "Don't wait until you're older or sick. You can complete an Advance Healthcare Directive when you turn 18."

Goldberg noted that creating the new packet was painstaking, but well worth the effort.

"The new directive is much more user-friendly and it really humanizes the person," said Goldberg. "They're sharing what they truly value in life and that informs how we provide care."

To further roll out the new packet, training sessions will be held for select areas, and overview presentations will be given across the medical center.

To request a training session, contact Margaret.ReedR@cshs.org.

Advanced Healthcare Directive (PDF)  

Step-by-Step Guide (PDF)  

Study Looks at Sudden Cardiac Arrest in Young People

Obesity and other common cardiovascular risk factors may play a greater role in sudden cardiac arrest among younger people than previously recognized, underscoring the importance of earlier screening, a Cedars-Sinai study has found.

While sports activity often garners attention in cases of sudden cardiac arrest in younger patients, it was cited only in a small percentage of those ages 5 to 34 in the study, published in Circulation, a journal of the American Heart Association.

Instead, investigators found an unexpectedly high prevalence of standard cardiovascular risk factors among the young who suffered from sudden cardiac arrest, a disorder that can cause instantaneous death. Combinations of obesity, hypertension, high cholesterol, diabetes and smoking were found in nearly 60 percent of cases studied.

The findings shed light on a public health problem among the young that has remained largely unsolved.

"One of the revelations of this study is that risk factors such as obesity may play a much larger role for the young who die from sudden cardiac arrest than previously known," said Sumeet S. Chugh, MD, associate director of the Smidt Heart Institute and lead researcher for the study.

Chugh suggested extending prevention efforts to routine preventive visits for children and young adults.

"The added benefit of such screenings is that early efforts to reduce cardiovascular risk are known to translate into reduction of adult cardiovascular disease," he said.

The findings come from the Oregon Sudden Unexpected Death Study. Chugh headed the comprehensive, 16-hospital, multiyear assessment of cardiac deaths in the Portland metropolitan area, home to one million people. Data collected in the study provided Chugh and his team with unique, community-based information to mine for answers to what causes sudden cardiac arrest.

Although "sudden cardiac arrest" and "heart attack" often are used interchangeably, the terms are not synonymous. Sudden cardiac arrest is the result of defective electrical activity of the heart. Patients may have little or no warning, and the disorder usually causes instantaneous death. A heart attack—myocardial infarction—typically is caused by clogged coronary arteries that reduce blood flow to the heart muscle.

The study was funded in part by grant R01 HL126938 from the National Institutes of Health, National Heart Lung and Blood Institute.

Transplant Saves Bishop at the Heart of His Community

Bishop William LaRue Dillard received a heart transplant at 78.

"It's the size of the heart that matters."

Bishop William LaRue Dillard was speaking quite literally when he shared this detail of how he came to be an 81-year-old clergyman with a heart 43 years younger than the rest of him.

He quoted his heart transplant surgeon as he sat in his office at the Second Baptist Church, surrounded by framed photos of his children and grandchildren, describing the traits necessary for a donor heart.

After months of waiting, on Sept. 5, 2014, Dillard and his wife, Betty Gay Dillard, got the call: "We have a heart for the bishop," said Jon Kobashigawa, chair of Heart Transplantation Medicine at the Smidt Heart Institute. Dillard was 78. The heart came from a 35-year-old father of four.

"The size of his heart fit right into mine," said Dillard. "It has been a monumental moment in my thinking, reflecting on his transition and my reception of that heart, which came just in time."

Dillard had been plagued by fits of coughing, trembling and shortness of breath for a while, but one morning he had a particularly frightening attack and decided he couldn't ignore them any longer.

"I knew something was drastically wrong," he said. "I went straight to my doctor. The nurses took one look at me and said they better get me in right away."

He was admitted to a local hospital, and a cardiologist referred him to the Smidt Heart Institute, where Dillard met Kobashigawa. Along with Dillard's previous diagnosis of an enlarged heart, Kobashigawa found he also had cardiac amyloidosis, a rare condition in which an abnormal protein builds up in the heart.

The only hope was a heart transplant.

Some heart transplant programs would have considered Dillard too old to undergo a transplant at 78.

But researchers at the Smidt Heart Institute have studied transplants in older patients and found that select patients age 70 and older can undergo transplantation with similar outcomes to younger recipients.

"Today, you'd never know he'd had a heart transplant," said Kobashigawa. "Every patient here gets a fair and objective evaluation, and we really weigh each case very carefully. We're happy we could help him."

The support of his congregation and the love of his family were instrumental factors in his recovery, said Dillard. The bishop shared his worries with the congregation, and they prayed for him.

"The skill of the surgeon, the discoveries that make operating rooms, anesthesia and heart transplants possible—these are gracious and miraculous gifts," said Dillard.

Dillard still leads the Second Baptist Church in Monrovia, where he's served the parish since 1974. He and Betty—whom he affectionately calls "Apple Blossom"—have five kids, a son-in-law and three grandkids.

It's the size of the heart that matters, and these days, Dillard's is overflowing with optimism and happiness.

Stop the Bleed Class Trains its 500th Student

The Department of Surgery's Trauma Program reached a milestone in their support of the National Stop the Bleed (STB) Campaign in February. Mirta Siderman, a supervisor from COACH for Kids®, was the 500th person to attend an STB course.

The STB course teaches participants how to recognize life-threatening bleeding and then allows time to practice the skills in hands-on situations. Programs such as STB help support the Cedars-Sinai mission by continuing to provide community service.

Introduced by the Obama administration in 2015, STB was created after learning that uncontrolled bleeding led to many deaths in the December 2012 mass shooting at Sandy Hook Elementary School in Newtown, Connecticut.

While law enforcement and other nonmedical first responders were the initial focus of STB, there's since been a national call to reach as many civilians as possible. Now overseen by the American College of Surgeons Committee on Trauma, STB's objective is to make bleeding-control techniques as accessible to laypeople as training is for CPR.

Registration for upcoming STB classes is available through the Department of Surgery Trauma Program's website.

Cardiac Surgery Resident Awarded Traveling Fellowship

Heidi Reich, MD, a cardiac surgery resident, is shown with Panos Vardas, MD, vice president of Thoracic Surgery Resident Association.

Heidi Reich, MD, a first-year cardiac surgery resident, has been awarded the 2017 TSRA/STS Traveling Fellowship in Cardiothoracic Surgery. The $5,000 fellowship funds a one-week observership with a host institution.

Reich plans to use the fellowship to learn total arterial grafting and intraoperative assessment of graft patency. Teresa Kieser, MD, PhD, will host Reich at the University of Calgary beginning Feb. 26.

The week will include observing at least four cases using total arterial grafting with intraoperative assessment of graft patency, daily teaching rounds, two multidisciplinary preoperative conferences and one afternoon of wetlab/skills simulation.

Hosting Summer Research Interns

If you would like to host a summer research intern, please notify Jesse Null, surgery and orthopaedics research manager.

The requirements for hosting a research intern are:

  • Research interns must start on the following dates: May 7, May 22, and June 12. These are the dates of the mandatory research intern orientation, hosted by Academic Human Resources.
  • Observational research internships can be unpaid, but for research interns to participate in any research activities, they must either be paid or receive academic credit.
  • Academic credit requires coordination with the research intern’s home institution.
  • Paid research internships must come from the PI’s discretional research accounts.
  • Research Intern Poster Day is Friday, Aug. 3. Ideally, the summer internship will end on this day.

For more information, contact Jess Null at 310-423-3575 or jesse.null@cshs.org.

Circle of Friends Honorees for January

The Circle of Friends program honored 90 people in January.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

See more information about the program and a list of past honorees.

  • Sonu S. Ahluwalia, MD
  • Erica A. Alvarado, RN, BSN
  • Laura G. Audell, MD, MS
  • Paula A. Barondess, CNMT
  • Ashley L. Beck
  • Eileen G. Brown, RN, OCN
  • Miguel A. Burch, MD
  • Lance Capisanan
  • Sonia Castillo, CP
  • Michael L. Chaikin, MD, FACC
  • Tarun Chakravarty, MD
  • Harry Chu, RN
  • Jeffrey Chung, MD, FAAN
  • Myles J. Cohen, MD
  • Laura O. Daniels, RN, BC, BSN
  • Pamma A. David
  • Robert M. Davidson, MD, FACP, FACC, FAHA
  • Kiana Delamare
  • Rama N. Escolin, RN
  • Shervin Eshaghian, MD
  • Joel D. Feinstein, MD
  • Phillip R. Fleshner, MD
  • Madelyn M. Foronda, RN, CRN
  • Stuart Friedman, MD
  • Srinivas Gaddam, MD
  • Alexandra Gangi, MD
  • Ashley N. Gianoulis, NP
  • Jeffrey R. Gramer, MD
  • John G. Harold, MD, MACC, MACP, FCCP, FAHA
  • Andrew E. Hendifar, MD, MPH
  • Fernando P. Hernandez, CP
  • David M. Hoffman, MD
  • Shao-Jung A. Hu, CNIII
  • Brandi N. Huber
  • Laith H. Jamil, MD
  • Stanley C. Jordan, MD
  • Beth Y. Karlan, MD
  • Terrence T. Kim, MD
  • Jon A. Kobashigawa, MD
  • Marie Kristine A. Lacar, RN
  • Melissa S. Lee
  • Andrew J. Li, MD
  • Carol A. Lin, MD
  • Katrina J. Lin, MD

  • Simon K. Lo, MD, FACP
  • John Bryan K. Magno, RN
  • Fataneh Majlessipour, MD
  • Rajendra Makkar, MD
  • Adam N. Mamelak, MD, FACS
  • Vicki A. Manoukian
  • Maya M. Mathew, MD
  • Ruchi Mathur, MD, FRCP(C)
  • Philomena McAndrew, MD
  • Monica M. Mita, MD, MDSc
  • Susan L. Mooney
  • Jaime D. Moriguchi, MD, FACC
  • Ronald B. Natale, MD
  • Edna Nepomuceno, CP
  • Nicholas N. Nissen, MD
  • Tiffany G. Perry, MD
  • Edward H. Phillips, MD, FACS
  • Mark Pimentel, MD, FRCP(C)
  • Edwin M. Posadas, MD
  • Pamela L. Richardson-Elex
  • Miranda Ripper, RN, BSN, RNC
  • Robert M. Rose, MD
  • Fred P. Rosenfelt, MD
  • Wendy L. Sacks, MD
  • Enrique Sanchez, CP
  • Yesenia Santana
  • Gregory P. Sarna, MD
  • Meghan M. Sarna
  • Jay N. Schapira, MD, FACP, FAHA, FCCP, FACC
  • Wouter I. Schievink, MD
  • Prediman K. Shah, MD
  • Bahman Shamloo, MD
  • Michael M. Shehata, MD
  • Robert J. Siegel, MD
  • R. Kendrick Slate, MD
  • Karyn Solky, MD
  • Vinay Sundaram, MD, MSC
  • Charles D. Swerdlow, MD
  • Heather D. Thompson, MS, CCC-SLP
  • Alfredo Trento, MD, FACS
  • Raquel A. Vasquez, MS, PA-C
  • Erica Vega
  • Robert A. Vescio, MD
  • Nicole R. Williams, RN
  • Christopher Zarembinski, MD
  • Raymond Zimmer, MD

Stenting System Benefits Certain Stroke Patients


Michael Alexander, MD

A specialized stenting system used to open blocked arteries in the brain resulted in a low complication rate among a specific group of patients with stroke histories, according to a study led by Cedars-Sinai researchers.

The Wingspan® Stent System Post-Market Surveillance Study (WEAVE™) examined patients with a narrowing of the arteries in the brain, called intracranial stenosis, resulting from a buildup and hardening of fatty deposits called cholesterol plaque. The condition can lead to strokes.

The trial demonstrated that stenting of brain arteries in these patients resulted in a complication rate of just 2.6 percent.

The results were presented last month at the International Stroke Conference in Los Angeles.

"These trial results have the potential to change how stroke patients are treated in the future," said Michael Alexander, MD, director of the Cedars-Sinai Neurovascular Center. "Using approved stents in the brain arteries may give new hope to patients suffering from stroke due to blockages from cholesterol plaque."

Alexander was the principal investigator for the national study. The research team included Shlee S. Song, MD, associate director of the Cedars-Sinai Stroke Center, as well as investigators from Mount Sinai Medical Center, Miami; Erlanger Medical Center, Chattanooga, Tennessee; Cottage Medical Center, Santa Barbara, Calif.; SSM Health System, St. Louis; and UC Irvine Health, Irvine, Calif.

The study tracked patients at 24 sites nationwide, including those at Cedars-Sinai. To be eligible, patients had to be between ages 22 and 80, have had two or more strokes, have significant narrowing of the arteries and have failed to respond to other forms of medical therapy.

Investigators found that of 152 patients with intracranial stenosis due to cholesterol plaque and treated with the Wingspan Stent System, just 2.6 percent experienced stroke or death within 72 hours of the procedure. Made by medical technology company Stryker, which sponsored the trial, the system has been approved by the U.S. Food and Drug Administration for use with patients who have intracranial atherosclerotic disease.

Disclosure: Alexander receives compensation from the company sponsoring the trial. This includes consulting fees and fees for speaking engagements.

FDA Updates Warning About Antidepressant Pristiq

The U.S. Food and Drug Administration has updated a warning about the antidepressant Pristiq (desvenlafaxine succinate) that it can lead to serotonin syndrome, a potentially life-threatening condition. The risk of suicidal thoughts and behaviors in pediatric and young adult patients is increased when used with other drugs that impair metabolism of serotonin.

The FDA has more information.  

FDA Issues Warning About Incorrect Dosing of Obeticholic Acid

The U.S. Food and Drug Administration (FDA) is warning that the liver disease medicine Ocaliva (obeticholic acid) has been incorrectly dosed daily instead of weekly in patients with moderate-to-severe primary biliary cholangitis (PBC), a rare chronic liver disease, increasing the risk of serious liver injury. To ensure correct dosing and reduce the risk of liver problems, the FDA is clarifying the current recommendations for screening, dosing, monitoring and managing PBC patients with moderate to severe liver disease taking Ocaliva.

The FDA website has more information.

FDA: Agency Seeks Packaging Limits for Anti-diarrhea Drug Loperamide

In an effort to foster safe use of the over-the-counter anti-diarrhea drug loperamide, the FDA is working with manufacturers to use blister packs or other single dose packaging and to limit the number of doses in a package. The agency continues to receive reports of serious heart problems and deaths linked to much higher than recommended doses of loperamide, primarily among people who are intentionally misusing or abusing the product. Loperamide is a safe drug when used as directed and helps control symptoms of diarrhea.

The FDA website has more information.

CS-Link Tip: Refilling Prescriptions

With CS-Link™, refilling prescriptions is simple. If you want to accept prescriptions, click on the "accept all" button.

If you don't have the "accept all" button on your toolbar, you also can find it under "more." However, it's easy to move the button to your toolbar.

The CS-Link™ website has more information.

Also, HealthStream offers physician efficiency training modules for continuing medical education credit. There are 22 modules that last 15 minutes each. They include topics such as "In Basket Quick Actions," "Smart Blocks in Progress Notes" and "SmartList Editor."

To take advantage, log into HealthStream and search the catalog using keywords: PET CME. Select the module you want to view, then click "Enroll."

If you have questions, contact groupeisphysicians@cshs.org.