Archive for the ‘Articles’ Category

Sentinel Device Reduces Stroke Risk for TAVR Patients

Andrew, Goldsweig, MD

At Nebraska Medicine, we are serious about heart health. With state-of-the art cardiovascular care, we lead the state with outstanding results and the latest in minimally-invasive surgical techniques. For patients undergoing Transcatheter Aortic Valve Replacement (TAVR), we are the first and only hospital in the region to offer the Sentinel Cerebral Protection System to reduce the risk of stroke during the TAVR procedure. Improving Quality of Life with TAVR

For patients with severe aortic stenosis, TAVR offers a minimally-invasive way to replace the diseased aortic valve through a pencil-sized tube inserted into a blood vessel in the leg, avoiding open-heart surgery. TAVR improves quality of life by making people both feel better and live longer. Patients who have aortic stenosis may have shortness of breath, chest pain, lightheadedness, and leg swelling. Replacing the valve alleviates these symptoms and improves cardiac function. In addition, patients with severe, symptomatic aortic stenosis have a life expectancy of only 2-5 years, but valve replacement returns their life expectancy to normal.

TAVR is currently approved for patients with severe aortic stenosis who are at intermediate or high risk for surgical aortic valve replacement (SAVR) due to their age or other medical issues. However, the indications are rapidly expanding. In March 2019, two major national trials of TAVR in patients at low risk for SAVR will present results, and these trials are expected to result in expansion of TAVR to low-risk patients. Also, Nebraska Medicine is participating in a major national trial called TAVR UNLOAD for patients with moderate aortic stenosis and heart failure who remain symptomatic despite maximal medical therapy. Through this trial, we are currently the only hospital in the region able to offer TAVR to such patients. When the trial results are published in 2-3 years, TAVR may become generally available for such patients at other hospitals.

TAVR is performed under conscious sedation with local anesthesia, similar to a colonoscopy. Patients are sleepy but do not require breathing tubes or machines. The prosthetic valve is crimped onto a catheter and delivered through a 0.2 inch (5 mm) tube inserted into a leg artery. The procedure usually takes less than 2 hours. Patients are up walking the next morning and typically spend between 24 and 72 hours in the hospital.

Risk of Brain Injury or Stroke During TAVR
Patients with severe aortic stenosis have aortic valve leaflets that are thickened and calcified. Most patients also have significant atherosclerotic plaque on the walls of the aorta. During TAVR, as a prosthetic valve is advanced through the aorta and into the calcified native valve, debris from the aorta and native valve leaflets may break off and travel with the blood stream up the arteries that feed the brain. When debris blocks blood flow to the brain, this causes a stroke.

The rate of any stroke during TAVR is less than 2%, and the rate of severe or disabling stroke is far less than 1%. However, these events are devastating when they occur, so we want to do everything we can to prevent them.

How the Sentinel Device Reduces Stroke Risk
The Sentinel Cerebral Protection System filters the blood passing through the arteries that supply the brain. It captures any debris that may otherwise make their way to branches of the brain arteries, preventing a stroke. The device is delivered at the beginning of the TAVR procedure with a small tube inserted through into a blood vessel in the right wrist. Using a tiny catheter, two filters are placed in the two main arteries feeding the brain. After the procedure, the filters are recaptured into the catheter and removed from the patient.

Adopting the use of the Sentinel for TAVR in October 2018, we were the first and remain the only hospital in the state offering cerebral embolic protection for TAVR. To date, we have performed approximately 25 Sentinel-protected TAVR procedures.

Patient Eligibility and Effectiveness of Sentinel Device

All patients undergoing TAVR are candidates for protection with the Sentinel device. In practice however, Sentinel can be used in approximately 90% of patients. In the remaining 10% of candidates, diseased and tortuous carotid arteries prevent its use. In randomized trials, TAVR patients with the Sentinel device experienced a 63% lower stroke rate than patients without Sentinel as well as a reduction in severe or fatal stroke.

The Benefits
When Sentinel is removed at the conclusion of each TAVR procedure, there is significant debris caught in the filters 99% of the time. This debris could have caused a stroke had it not been captured by the Sentinel device. Patients and families are particularly impressed when they see a photograph of the captured debris after the procedure.

Here is a photograph of the debris captured in our very first use of the Sentinel device:

Here is a photograph of the debris captured in our very first use of the Sentinel device: Potential Risks It’s important to remember that any medical procedure caries some risk of bleeding or infection. However, Sentinel is a very small device at insertion (0.08 inches or 2 mm in diameter), so the risks are very low. In theory, the Sentinel could scrape plaque from the carotid arteries and cause a stroke with deployment; therefore, we are very careful to image the carotid arteries with both a CT scan and an angiogram prior to deploying the device. At Nebraska Medicine, we care about your heart health. Learn more about TAVR and heart care highlights at Nebraska Medicine, as well as news coverage of our use of the Sentinel device. Also, see our video interview that offers new hope for patients with valve disease.

UNMC Joins Network to Combat Viral Diseases

Chris Kratochvil, MD

The University of Nebraska Medical Center have joined the Global Virus Network (GVN), a worldwide network of members from 29 countries combating major threats posed by various human viruses. The network represents experts at 45 Centers of Excellence and seven affiliates in 29 countries recognized for expertise in infectious diseases in every class of virus causing disease in humans. Work includes drug development, research, training and education in the areas of biocontainment and antiviral therapeutics preparedness, defense and first research response to emerging, exiting and unidentified viruses that pose a clear and present threat to public health. Criteria for a GVN Center of Excellence includes a productivity and expertise in two to three viral areas, a commitment to capacity building, particularly in resource-poor nations and a commitment to support the GVN central operation through inclusion on grant and contract applications, fundraising events, direct donations or other means. UNMC is one of three of GVN’s newest Centers of Excellence invited to join the network. UNMC was selected because of its long history of significant viral research activities and for leading a unique array of initiatives that include innovative basic and translational research, a special pathogens clinical trials network and multiple global public health initiatives. The two other centers are the West African Centre for Cell Biology of Infectious Pathogens at the University of Ghana and Colombia-Wisconsin One-Health Consortium in Madison, Wisconsin. Howard Gendelman, MD The UNMC center will be led by Christopher Kratochvil, MD, UNMC associate vice chancellor for clinical research and vice president for research at Nebraska Medicine and Howard Gendelman, MD, Margaret R. Larson professor of Internal Medicine and chair of the UNMC Department of Pharmacology and Experimental Neuroscience. Among other things, UNMC will deepen the network’s expertise in improved therapies against HIV and biosecurity. “This opportunity and recognition as a Center of Excellence would not have been possible without our incredible partnership with Nebraska Medicine and our many University of Nebraska collaborations,” says Dr. Kratochvil. Dr. Gendelman says UNMC is looking forward to working with the GVN to establish and foster further collaboration domestically and abroad, to include drug development, research, training and education in the areas of biocontainment and antiviral therapeutics. “The breadth of activities from both of our organizations is significant, and significantly overlapping. We also look forward to working to develop medicines for the treatment, prevention and elimination of viral diseases through UNMC’s antiviral production facilities and other research resources,” he said. GVN President Christian Bréchot, MD, PhD, says adding the new centers to the network is an important step for GVN’s development. “Indeed, the GVN is reinforcing its expertise in biosecurity by bringing together centers such as the UNMC and those working in the most basic aspects of research on human viruses,” says Dr. Bréchot, who also is the Homer & Martha Gudelsky Distinguished Professor in Medicine and director of the Institute of Human Virology at the University of Maryland School of Medicine.

Howard Gendelman, MD

U.S. Air Force, Nebraska Medicine, UNMC Collaborate on C-STARS Omaha

U.S. Air Force, Nebraska Medicine, UNMC Collaborate on C-STARS Omaha December 17, 2018 In The Community The University of Nebraska Medical Center, Nebraska Medicine and the Air Force Research Laboratory are partnering to form the Center for Sustainment of Trauma Readiness Skills (C-STARS) Omaha. C-STARS Omaha focuses on advancing the readiness skills and competency of U.S. Air Force (USAF) medical personnel who provide safe and effective care for patients who have contracted or may have been exposed to highly hazardous infectious diseases, such as the Ebola virus.

Maj. Elizabeth Schnaubelt, MD, medical director of the C-STARS Omaha unit.

“Through this collaboration, we will train USAF health care professionals by leveraging UNMC expertise and best practices on infection prevention and control procedures for biocontainment care,” says Maj. Elizabeth Schnaubelt, MD, medical director of the C-STARS Omaha unit. The training program includes didactic lectures, simulation experiences and hands-on skills training modeled after the well-respected Nebraska Medicine Biocontainment Unit team. The program also will incorporate a train–the-trainer model so that USAF teams who have completed the C-STARS Omaha training can instruct other military medical professionals on biocontainment care when they are deployed to provide care outside of the United States. “The focus is on infectious diseases, those highly hazardous and contagious illnesses that troops might encounter,” says Dr. Schnaubelt. The 2014–2016 West Africa Ebola outbreak highlighted the need for such training when the Department of Defense deployed service members to support the U.S. government’s response to the Ebola crisis. Since then, the development of a C-STARS unit focusing on infectious diseases became a priority. The Omaha C-STARS unit is one of five; others are located in Cincinnati, Ohio; Baltimore, Maryland.; St. Louis, Missouri and Las Vegas, Nevada. Each unit has a different specialty focus. “This collaboration is based upon a strong underlying partnership with the U.S. Air Force and a recognition of the potential synergy in working together to develop and deliver training,” says Chris Kratochvil, MD, vice president of Research for Nebraska Medicine and associate vice chancellor for Clinical Research at UNMC. The USAF has assigned four members to the C-STARS Omaha team. The team includes an active duty infectious diseases physician, a clinical nurse, a public health technician and an administrator. “This is an incredible opportunity for the U.S. Air Force to partner with UNMC and Nebraska Medicine, world-renowned for their expertise in biocontainment care, innovative research and exceptional commitment to advancing quality health care and education. I feel very fortunate to be a part of this important project to enhance the preparedness of U.S. Air Force medical personnel,” says Dr. Schnaubelt.

Hip Replacement Relieves Patient’s Physical, Mental Anguish

Beau Konigsberg, MD, goes over Cathy Sickler’s most recent x-rays during her one-year check-up appointment after having her right hip replaced.

You know that short walk you take to get your mail, or the steps you take from one end of the grocery store to the other? We complain about it being too cold outside or the crowds of people we have to maneuver past, but Cathy Sickler isn’t complaining – not anymore.

“Every day when I get up and walk and feel myself walking normally again, in my heart, I am so thankful for this moment,” Sickler says while at her one-year post-operation checkup. “I don’t feel like I have very many limitations at all.”

It has been one year since Sickler’s quality of life began to improve when she had her right hip replaced. Leading up to her procedure, she had been experiencing hip discomfort for years, due to a labrum cyst, arthritis and ligament strain.

“The pain was so bad that I couldn’t get groceries, had a hard time going up and down my stairs to let my dogs out … I started getting depressed and thought it would never stop hurting,” she says. “I was a train wreck.”

When there were no other options but to have her hip replaced, she put her trust in the hands of orthopaedic surgeon Beau Konigsberg, MD, and the rest of her health care team at Nebraska Medicine.

Beau Konigsberg, MD, checks Cathy Sickler’s range of motion in her right leg, during her one-year checkup after having her hip replaced.

Leading up to the procedure, Sickler was anxious about everything from potential anesthesiology side effects to making sure her legs were both the same length after the hip replacement. She was comforted by the expertise and reassurance she received from her care team.

“I can’t stress enough about how much it was a total team here of people working together to make sure everything leading up to the procedure and after was a success,” she says. “They really seemed to tailor everything to a personalized plan.”

Sickler adds that the time spent by Dr. Konigsberg with her leading up to the procedure was invaluable, and helped give her confidence that everything would go as planned.

“Dr. Konigsberg took the time to figure out who I was and what I was about and it helped him understand how to best communicate with me,” she says. “He realized that I have to really be sold on the best option and told me like it was, and I really appreciated that transparency and honesty.”

A year removed from having her hip replaced, Sickler has regained her independence back and is back to being able to do more physical activity.

“Before, I couldn’t walk to the mailbox. Now, I could walk five miles if I had to. When I walk into the gym, I walk like a boss,” she says with a laugh. “I don’t have a big enough word to describe what this entire experience has meant to me. I’m just so grateful to Dr. Konigsberg and everyone at Nebraska Medicine who helped me.”

With Right Treatment, Most Epilepsy Patients Can Live Normal Lives


Treatment and management of epilepsy continues to evolve and improve. With the right diagnosis and treatment, most patients can live a normal life.

We have made great advancements in epilepsy treatment over the last 20 years with more medications, advanced diagnostic tests and more precise surgical techniques.

While the treatment of epilepsy has made great strides, awareness of this unpredictable disease has not kept pace. It is still not uncommon for people with epilepsy to be misdiagnosed with something else.

Having Uncontrollable Seizures?
Get evaluated by the experts. To make an appointment with one of our epilepsy specialists at the Nebraska Medical Center campus or our new clinic in Bellevue, call 800.922.0000. Visit us online to learn more at

Epilepsy is estimated to occur in as many as 20,000 individuals in Nebraska. Depending on what part of the brain the seizure is originating from, it can trigger different types of symptoms. These include symptoms ranging from involuntarily screaming, laughing inappropriately, falling to the ground in convulsions, to less noticeable symptoms such as falling into an unconscious stare or state of confusion and not remembering what happened during the incident.

Arun Swaminathan, MD, epilepsy specialist

As a result, the more subtle seizures are sometimes misdiagnosed as a small stroke, depression, anxiety or hallucinations. That’s why it’s very important to come to an experienced epilepsy center like ours to ensure you receive the correct diagnosis. The type and combination of drugs prescribed for each individual depends on the specific type of epilepsy and its point of origin in the brain.

Early diagnosis and treatment is also important to prevent the disease from progressing and causing long-term side effects. Untreated, recurrent seizures can cause progressive changes to the epileptic networks in the brain and worsen seizures over time.

The Nebraska Epilepsy Center, the only comprehensive epilepsy center of its type in the region, diagnoses and treats epilepsy patients from children to adults, using some of the most advanced diagnostic and treatment tools available.

One of these tools is the MEG scanner, which uses magnetic fields generated by the brain’s neuronal activity to detect seizure activity with greater detail and accuracy than previous testing tools. By allowing doctors to identify exactly where the brain is malfunctioning, the MEG improves doctors’ ability to diagnose and treat the disorder with the appropriate medications and provides greater surgical precision when removing the lesion becomes necessary.

Using the appropriate medications can make a significant difference in managing seizures. Sixty to 70 percent of patients can become seizure-free on the proper medications. The remaining 30 to 35 percent will need surgery combined with medications.

I specialize in brain surgery to treat epilepsy for these more complex cases. This includes less invasive laser procedures to destroy the parts of the brain that are triggering the seizures; open surgery to remove the seizure trigger points; as well as surgery that involves implanting a computer chip into the brain or neck to detect and prevent seizures.

The future continues to look promising for epilepsy. Treatments continue to improve and there are many new medications and therapies on the horizon.



About the Author

Arun Swaminathan, MD
Epilepsy specialist

New BrainPath® Technology for Treating Hemorrhagic Stroke Now Available at Nebraska Medicine – Nebraska Medical Center

Andrew Gard, MD

There are two common types of strokes, ischemic and hemorrhagic (bleeding) stroke. Ischemic stroke is the most common type of stroke, accounting for the majority of stroke cases. Although hemorrhagic strokes account for only 15 percent of all stroke cases, it is the deadliest form of stroke. The location of the bleeding is an important factor in determining the cause of the stroke, as well as the treatment.

Bleeding within the fluid-filled space surrounding the brain is called a subarachnoid hemorrhage. A common cause of subarachnoid bleeding is a ruptured brain aneurysm. Please see our previous post regarding brain aneurysms.

When you come to Nebraska Medicine, you can be sure you will receive the best care available from a highly skilled and dedicated stroke team, providing you or your loved one the best chance for a full recovery. Nebraska Medicine – Nebraska Medical Center is the only certified Comprehensive Stroke Center in the state.

Bleeding within the brain substance itself is called an intracerebral hemorrhage (ICH). ICH can be due to a blood vessel bursting within the brain tissue. The bleeding causes injury directly to the brain by destroying brain cells along its path, but also indirectly by forming a thick clot which causes pressure injury to the brain tissue surrounding the blood clot. As the body tries to dissolve the blood clot, there may also be swelling around the clot, as well as an irritating chemical reaction with the breakdown of the clot. Both of these processes lead to poor outcomes in patients with hemorrhagic stroke.

The location of the bleeding is an important factor in determining the cause of the stroke, as well as the treatment.

For large, symptomatic ICH, surgery may be indicated to improve survival and progression. For many years, surgery for hemorrhagic stroke was limited because these bleeds are often deep within the brain. Surgically accessing these deep hemorrhages previously involved large openings with possible injury to the overlying brain tissue.

Now at Nebraska Medicine – Nebraska Medical Center, we have newer technology that allows for a minimally invasive approach to evacuating deep symptomatic ICH. This minimally invasive approach utilizes small tubular retractors (BrainPath) to gently spread the brain fibers apart as well as improved visualization. These tools allow us to evacuate the clot and reduce brain injury from the clot itself. After treating the patient for ICH, we continue to identify and correct risk factors for future stroke, including high blood pressure, bleeding disorders or other structural abnormalities.

To schedule an appointment with a Nebraska Medicine stroke specialist, call 800.922.0000.


About the Author

Andrew Gard, MD

Cancer Research Accelerates New Therapies

From left to right; Chi Lin, MD, PhD, radiation oncologist, Michael Hollingsworth, PhD, researcher and Surinder Batra, PhD, researcher

One of the differentiators of the Fred & Pamela Buffett Cancer Center is the integration of scientists and clinicians, which allows them to collaborate in the evaluation of our cancer patients to design new treatments.

One example of this bench-to-bedside research coming to fruition can be seen through the collaboration of Chi Lin, MD, PhD, a radiation oncologist and researcher Surinder Batra, PhD, associate director for education and training at the Fred & Pamela Buffett Cancer Center. Through Dr. Batra’s basic science research lab, a pathway was discovered in which cholesterol is converted into other compounds in pancreatic cells that contributes to radiation therapy resistance. Dr. Batra’s lab then found another drug that is effective in inhibiting this cholesterol synthesis pathway, thereby increasing radiosensitivity in tumor cells.

This laboratory discovery is now available to patients through a clinical trial that combines chemotherapy with this drug to sensitize pancreatic tumors to radiation. “This is very important because current protocols for radiation therapy are very limited in their effectiveness on pancreatic tumors,” says Michael Hollingsworth, PhD, associate director for Basic Research at the Fred & Pamela Buffett Cancer Center.

“While pancreatic cancer is still extremely difficult to treat, we are making huge progress in understanding the disease,” says Dr. Hollingsworth.

“Our goal is to turn these discoveries into improved diagnostics, new therapies and other ways to improve survival and quality of life for these patients.”

Nebraska Medicine Once Again Ranks Among the Best


Becker’s Hospital Review recently released the 2018 edition of the “100 hospitals and health systems with great oncology programs” list and Nebraska Medicine holds an esteemed spot on it.

The hospitals and health systems selected for this list are at the forefront of cancer treatment and research. Like many of the institutions featured, Nebraska Medicine has earned National Cancer Institute cancer center designation.

In June 2017, Nebraska Medicine opened the Fred & Pamela Buffett Cancer Center, which features a 24/7 infusion center that serves as a treatment facility and provides urgent care services. As the only National Cancer Institute-designated cancer center in Nebraska, the Fred & Pamela Buffett Cancer Center comprises more than 200 specialists and researchers.

The Becker’s list also includes cancer centers with busy research institutes, multiple clinical trials and safety designations that exceed national benchmarks. Hospitals and health systems highlighted here have invested in growing oncology departments and regional cancer centers, providing an important service to patients locally and nationally.

“We are grateful to be included on Becker’s List for the 100 Great Hospitals in America in 2018 and are equally proud to be included on their list of 100 hospitals and health systems with great oncology programs,” says Sarah Thayer, MD, PhD, surgical oncologist and physician-in-chief at the Fred & Pamela Buffett Cancer Center. “I consider these designations as living examples of how our team works together on behalf of the patient. Our ability to see through different lenses while treating holistically sets our team and hospital apart.”

View the list of all the hospitals and health systems that received the Becker’s Hospital Review designation.

UNMC leading national study to test drug to treat life-threatening illness

Stem cell transplants have saved countless lives of patients with blood cancers and other diseases. But, a side effect of the life-saving treatment also can rob patients of quality of life and in some cases, their life.

Vijaya Bhatt, M.B.B.S., University of Nebraska Medical Center assistant professor of internal medicine and oncology/hematology, has received a grant for up to $1.2 million to determine if a drug called ruxolitinib, is effective for treating a certain type of graft versus host disease (GVHD) called sclerotic. The grant is funded by Incyte, a global biopharmaceutical company.

UNMC and its clinical partner, Nebraska Medicine, are world-renowned for their expertise in transplantation and are only one of the few centers nationwide testing the drug for the purpose of treating GVHD.

The drug, which reduces inflammation, has proven effective for other uses, and shows promise as a treatment for patients who develop GVHD after receiving an allogeneic transplant. An allogeneic transplant uses a matching donor’s cancer-free stem cells, which are then infused into the cancer patient.

Sometimes donor cells attack the recipient’s healthy tissues and organs, which can impair function and is a significant cause of medical problems, including death.

Dr. Bhatt, principal investigator of the study, said GVHD is difficult to treat since first line treatments often fail.

Finding another treatment is important because of an estimated 40,000 patients undergo allogeneic stem cell transplants every year and about 30 to 50 percent of patients develop acute GVHD and about 30 to 70 percent develop chronic GVHD. The research team will focus on the chronic GVHD, which comes on slowly and continues sometimes for years.

Dr. Bhatt and co-principal investigator, Stephanie Lee, M.D., at Fred Hutchinson Cancer Research Center in Seattle, will recruit 47 study participants from five centers: UNMC, Fred Hutchinson, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Fla.; University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh Cancer Institute; and the Cleveland Clinic Cancer Center, Cleveland, Ohio.

The UNMC study site also will involve Ram Mahato, Ph.D., professor and chairperson in the UNMC College of Pharmacy Department of Pharmaceutical Science, and Lynette Smith, Ph.D., assistant professor in the UNMC College of Public Health Department of Biostatistics.

“When I joined UNMC three years ago, I felt the need to work on improving care of patients with GVHD,” Dr. Bhatt said. “Since then, we’ve established a multidisciplinary team in which we work with other providers who are instrumental in helping treat our patients.”

He said patients who’ve been treated with the drug have experienced good results so far. “It seems to be effective and doesn’t have as many side effects as some of the other medications,” he said.” Our hope is that it will improve how patients feel and improve the quality of their life.”

We are Nebraska Medicine and UNMC. Our mission is to lead the world in transforming lives to create a healthy future for all individuals and communities through premier educational programs, innovative research and extraordinary patient care.

Bariatrics Center Earns Reaccreditation

The Bariatrics Center at Nebraska Medicine was recently awarded the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Center of Excellence.

“The MBSAQIP designation is an important program certification, because it shows our commitment to the care of the bariatric patient,” says Corrigan McBride, MD, Bariatrics Center medical director.

MBSAQIP works to advance safe, high-quality care for bariatric surgical patients through the accreditation of bariatric surgical centers. A bariatric surgical center achieves accreditation following a rigorous review process during which it proves that it can maintain certain physical resources, human resources and standards of practice. The hospital is reviewed every three years to ensure it has all the equipment, personnel and resources to care for patients.

“As part of the review process, we track all our patients for their quality outcomes,” says Dr. McBride. “The process shows our dedication to continuously improving the care of our bariatric surgery patients.”