Blending art and science: USF Health neurologist transforms stroke care through clinical trials

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By Dave Scheiber

Inside a Tampa General Hospital operating room hangs a framed watercolor painting that depicts an average day in the angiography suite. The artist: Dr. Maxim Mokin, professor of neurosurgery, brain and spine in the USF Health Morsani College of Medicine. Such creativity is integrally entwined in the vascular and interventional neurologist's cutting-edge stroke research and patient care.

"One of the reasons I like the field I chose for my practice is that it's highly visual," he said. "We look at blood vessels. We look at blood flow. There is a certain degree of art in trying to understand how different patterns of blood vessel branching represent a normal anatomical variance versus a true abnormality."

Mokin and his team are helping transform the landscape of stroke care through innovative clinical trials and advanced neuro-interventional approaches, with the goal of determining which devices are safest and easiest for physicians to employ. USF Health and TGH are among the nation's busiest clinical research trial sites for acute stroke management and treatment.

"I'm quite proud to say that often what we have at TGH are some of the latest tools that very few centers initially get to use and test," said Mokin, vice chair of research for the USF Health Department of Neurosurgery, Brain and Spine and director of USF's Center of Excellence for Aging and Brain Repair.

Those state-of-the-art tools are essentially catheters for when time is of the essence - slender tubes that allow doctors to open up vessels to treat occlusions more quickly and effectively. By pioneering the use of the latest catheter technologies, Mokin and his team ensure that patients receive fast, effective treatments that minimize brain damage and maximize recovery.

Mokin recently treated a patient with a potentially deadly brain condition: well-known Tampa artist Charles Greacen. It was discovered by accident when Greacen participated in a free Cleveland Clinic sleep brain study that looks for certain markers related to early onset dementia.

Greacen learned he had a brain aneurysm, a bulge in a blood vessel wall that could lead to a brain bleed and result in a major disability or death if it ruptured. He was recommended to Mokin, who performed a successful outpatient procedure called an embolization.

"They were able to go through the arteries and deliver a little expandable basket that filled that aneurysm and effectively shut it off," Greacen said. "I truly bonded with Dr. Mokin and felt absolute confidence in his skills. And I feel very lucky that we have a facility in the area that does such advanced research and care."

In fact, USF Health and TGH were among the first in the country to treat a patient as part of a multi-site clinical trial that evaluates a groundbreaking treatment for patients suffering ischemic stroke. In the trial, a blood clot is removed from the patient's brain using specialized catheters that are highly flexible, allowing them to enter blood vessels in the brain and get closer to the treatment site compared to most other older catheters that are unable to get past the patient's neck.

In addition to being highly navigable, the catheter tip has a unique design to effectively trap and engage the clot. Mokin served as principal investigator on the study, which enrolled 262 patients from some 30 sites in the U.S..

"These catheters are now used by many physicians in the United States," Mokin said. "But USF Health and Tampa General were one of the first places in the country to get this technology a couple of years ago, and the company (Imperative Care) trusted us to test its efficacy. And it speaks to the quality of research performed here."

One of the aspects that Mokin is most proud of regarding the trial is the particular population of stroke patients selected to participate. He stresses that patients were not "cherry-picked" from a small pool, which could skew results, but represented a wide array of real-life stroke patients seen on a daily basis.

"We made sure that we analyzed very carefully what the population of patients we treat on a regular basis is versus the ones we treated as part of the trial. And we found the patients enrolled were highly representative of what an average stroke patient would look like."

In addition to clinical investigations, Mokin's team has several research projects supported by National Institutes of Health grants that are dedicated to examining fundamental questions about stroke. What causes a stroke and what happens to the brain on a cellular level?

"We work very closely not just with our neurology stroke team, but also USF's Department of Electrical Engineering because they helped us come up with a tool to understand how blood flows through the brain during active states," he explained.

The optical monitoring tool uses fiber optics to emit light and capture a returning signal. The light monitors blood flow to the brain during surgery and provides surgeons real-time information. Any abnormalities in how the light travels alerts doctors to a potential problem, such as a stroke or brain bleed.

Mokin is now exploring a promising new direction for his research called neuro-protection - which looks for new ways to minimize the damage that has been done to the brain and helping patients recover as quickly as possible.

"This could be applied the very first time a patient comes to the ER, or it could be applied in the rehab setting," he said. "As you know, stroke recovery often takes weeks and months, and both patients and caregivers suffer. So, if we can improve this process by 10 to 15 percent, that would be a tremendous help to the community."

Given the intensity of his work, Mokin embraces the escape and relaxation offered by painting. It's been a passion of his since childhood, even though he never received formal training. His works have even been sold at local fundraising events, such as at a benefit for the USF Health BRIDGE Healthcare Clinic, as well as nationally, at a Society of Vascular and Interventional Neurology event.

In the field of stroke research and patient care, Mokin is a true artist.