Michael Chen

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michael chenMichael Chen—a neurointerventionist and professor of Neurology, Neurosurgery and Radiology at Rush University Medical Center in Chicago, USA—speaks to NeuroNews to provide insight on his career, the ever-evolving world of neurointervention, and also his role in ongoing efforts to optimise USA-wide stroke triage and transport protocols as president of the Society of NeuroInterventional Surgery (SNIS).

What initially attracted you to medicine, and the field of neurointervention specifically?

My father was an obstetrician-gynaecologist (OB-GYN), so I saw first-hand the life of a physician who takes call from an early age. Neurology fascinated me because each patient seemed like a mystery to be solved. Success depended on attention to detail, knowledge, and being thoughtful. I was taught early on that an accurate diagnosis was one of the most important things you could do to help a patient. But, what neurointervention also offers is a chance to directly provide therapies using your own abilities as a technician—to, at times, profoundly improve the lives of patients. Hence, neurointervention to me represented a series of worthwhile, fascinating and challenging mysteries.

Who have your mentors been and how have they impacted your career?

I have been blessed to have trained alongside inspiring teachers, including the late Lawrence Brass while I was at Yale, Louis Caplan while I was at Beth Israel Deaconess, and Philip Meyers, John Pile-Spellman and Sean Lavine while at Columbia. Being able to observe specific ways each of them practiced medicine influenced my mindset, habits and values in a profound way that has persisted after many years. Now, I am also fortunate to continually learn from my many colleagues on the board of SNIS and the Journal of NeuroInterventional Surgery, as well as my partners, Webster Crowley and Stephan Munich.

What has your experience been as the president of the Society of NeuroInterventional Surgery?

The experience so far has been one of paying attention, lots of phone calls/meetings, and really just a greater appreciation for all the enthusiasm, hard work and dedication among the staff, board of directors and active members. As such, I have felt, this year as president, a real responsibility to serve SNIS with leadership that is thoughtful, growth-oriented and patient-focused. It is a unique experience— not something I feel completely at ease with, but something that I am committed to, passionate about and fortunately I have many colleagues on the board to help with the more difficult decisions.

How have you attempted to advance minimally invasive surgery and endovascular stroke care during your tenure as SNIS president?

By balancing the competing needs of multidisciplinary growth with the essential principles of prioritising patient care. There have been a few recently published retrospective studies showing self-adjudicated outcomes to be similar regardless of one’s training background, with the over-reaching extrapolation being that cardiologists and interventional radiologists should be performing stroke thrombectomy. This type of analysis misses the point. The importance of one’s training background, which recedes further back every year, pales in comparison to the importance of whether one is, in fact, well-trained. Being well-trained requires a knowledge base, practice and takes time. Shortcuts in training are short-changing the patient. Hence, one of my main priorities in this role has been trying to steer these conversations away from being too preoccupied about one’s speciality and more towards what it takes to be a truly effective, patient-focused neurointerventionist. This is not easy, but the more the community can work together to achieve this—instead of worrying so much about one’s training background—the faster we can progress as a field.

Why is the Get Ahead of Stroke campaign needed, and what are its main goals?

Get Ahead of Stroke is a national public education and advocacy campaign designed to improve systems of care for stroke patients in the USA. Founded in 2016 by SNIS, today the campaign is supported by a coalition of organisations with the goal of securing the best possible outcomes for stroke patients by driving policy change and public awareness nationwide. Specifically, the campaign’s focus has been, at a state level, on facilitating legislation that improves severe stroke triage to hospitals that perform thrombectomy, as well as educating first responders on the most relevant principles and concepts that guide stroke triage.

Michael Chen

What do you feel has been the most important development in the field of neurointervention during your career?

I have been in practice for 15 years. The only proven treatment for acute stroke when I first started was alteplase. So much investment by different organisations went into hospital certifications, very strict rules (e.g. long list of inclusion and exclusion criteria) and certain preconceived notions that, in and of themselves, served as an impenetrable barrier to thinking about and developing new therapies. Fortunately, we are seeing the gradual but steady dissolution of these now obsolete concerns, such as the role of elapsed time and even computed tomography perfusion (CTP) as a surrogate marker for salvageable brain. The same goes for using 90-day modified Rankin Scale (mRS) as a universal outcome measure. Our understanding of how to efficiently triage, treat and measure outcomes is now going through more rapid changes after a long period of stagnation. This paradigm change is so essential to the progress in acute stroke therapies our patients need.

What is the most significant unmet need in neurointervention right now?

Large vessel ischaemic stroke affects an order of magnitude more people than all other conditions treated with neurointervention. Yet, most patients, despite blood flow restoration with thrombectomy, end up with significant disability and/or death. Therefore, the most significant unmet need is optimising access to thrombectomy, much like trauma, such that first responders can accurately and efficiently determine stroke severity and triage them to hospitals that can perform thrombectomy. Meaningful improvement in access to thrombectomy would be the single most effective measure to reduce the burden of emergent large vessel ischaemic stroke. This is not an easy problem to solve—but doing so would be extremely powerful in meaningfully reducing the burden of stroke on society.

Besides your own work, what is the most interesting piece of neurointervention research you have seen in the past year?

The most important bottleneck currently in delivering thrombectomy to large vessel stroke patients is access to treatment. Artificial intelligence software that expedites the interpretation of a head computed tomography angiography (CTA) in a stroke patient holds so much promise to decrease the latency to thrombectomy treatment. You no longer have to wait for an emergency room physician or on-call radiologist to interpret the image and notify the thrombectomy-capable hospital. Once the images are acquired, the rest is taken care of automatically. There has been widespread adoption of this technology, which is becoming more refined to improve accuracy and efficiency of stroke triage in large vessel occlusion.

What advice would you give to people embarking on a career in neurointervention?

Read all the time. Write often. Be humble. Learn from others, including patients and especially other neurointerventionists from different training backgrounds. Do not keep doing the same thing or hanging around the same type of people. Stay away from echo chambers and keep challenging what you think you already know. You may be faced with situations where you can exploit situations for your own financial or egotistical gain. Choosing what the patient needs over these competing forces takes real strength of character and a practised discipline of values. In the book, The Remains of the Day, Kazuo Ishiguro illustrates how butlers maintain focus on their jobs despite a variety of distractions, including insults, indiscretions, and attacks. He summarises by discussing the elite Hayes Society criteria for membership, which to me has relevance to careers in neurointervention. Ishiguro captures the essence of Hayes Society butlers in possessing ‘a dignity in keeping with his position’.

What are your interests outside of the field of medicine?

I am currently trying to recover from a shoulder injury, but I would normally most love to be playing tennis either with my daughter, who plays competitively, or friends. I drive my other daughter around a lot and cheer for her hockey team, the Chicago Young Americans. At home, I enjoy smoking meats— especially beef brisket for family and friends—along with too much red California wine from Hall, Scarecrow and Kosta Browne vineyards. I have also rediscovered the joys of reading good books, ranging from Jack Reacher novels to Michael Lewis, to Dostoyevsky.

 

Fact file:

Current appointments:

  • Professor, Departments of Neurology, Neurosurgery and Radiology, Rush University Medical Center, Chicago, USA

Education:

  • 2005–2007: Fellowship, Interventional Neuroradiology, Columbia College of Physicians and Surgeons/New York Presbyterian Hospital, New York, USA
  • 2004–2005: Fellowship, Stroke and Cerebrovascular Disease, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, USA
  • 2000–2003: Residency, Neurology, Yale University School of Medicine, Yale New Haven Hospital, New Haven, USA
  • 1995–1999: Doctor of Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, USA

Honours (selected):

  • 2021–present: President, Society of NeuroInterventional Surgery
  • 2021–present: Chair, Neurosurgery Research Committee, Rush University Medical Center
  • 2013–present: Commissioning Editor, Journal of NeuroInterventional Surgery
  • 2017–2021: Top Doctors Award, Chicago Magazine/Castle Connolly

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