Career of Eminent Stroke Researcher Chelsea Kidwell, MD, Comes Full Circle

Thursday, October 1, 2015

As the daughter of two university scientists, Chelsea Kidwell was inspired to follow in their footsteps. After graduating with a degree in psychology from Duke University, she enrolled in the UA College of Medicine, where she made the choice to devote her career to neurology.  She was named Outstanding Neurology Student of the Year when she graduated in 1992.

Today, Dr. Kidwell is internationally recognized for her pioneering stroke research, including her work with medical imaging to improve the treatment and prevention of stroke

Her recent contributions include helping write the new stroke treatment guidelines published in June by the American Heart Association/American Stroke Association.

“It was very gratifying,” said Dr. Kidwell, who ran an early large clinical trial of endovascular thrombectomy for ischemic stroke patients, using a catheter to insert a stent retriever device to remove the blood clot from the brain. Although her trial (MR RESCUE, published in the New England Journal of Medicine in 2013) showed no benefit to patients with first generation devices, subsequent studies using new generation stent retrievers have shown clear benefit for up to six hours, and the new AHA/ASA guidelines endorse the treatment.

Chelsea Kidwell (who changed her name from Stella after medical school) grew up in Rhode Island, where her parents were both on the faculty of Brown University. After her father, the late James F. Kidwell, PhD, a population geneticist, developed early Parkinson’s disease, her parents moved to Tucson. Her mother, Margaret G. Kidwell, PhD, joined the UA as professor, then chair of the Department of Ecology and Evolutionary Biology.

After getting her MD, she went to UCLA for her internship, residency and a two-year stroke fellowship.

“Stroke seemed like an obvious choice for me,” she recalled. “The first proven treatment for acute stroke – tPA, or tissue plasminogen activator – was approved when I was a resident. It was exciting to have a treatment for a neurologic disease, particularly when that treatment could be easily administered and significantly improve patient outcomes.’

In 2004, Dr. Kidwell accepted Georgetown University’s offer to direct its stroke program. It was there that she ran the thrombectomy trial.

The UA Department of Neurology recruited her back to Tucson in 2013, as professor and vice chair for research in the Department of Neurology.

She also is professor of medical imaging; a member of the Sarver Heart Center and the BIO5 Institute; and co-medical director of the certified Primary Stroke Center at Banner-University Medical Center Tucson (formerly the University of Arizona Medical Center).

She also directs the Department of Neurology’s stroke research team, with Bruce Coull, MD, professor of neurology and medicine and past head of neurology, and Kendra Drake, MD, associate professor of neurology and pharmacy practice.

“There are opportunities here to expand our clinical research program, which include imaging stroke to understand its pathophysiology, understanding and addressing disparities in stroke care in underserved populations, and improving acute stroke therapies, as well as secondary stroke prevention,” Dr. Kidwell said.

“This is an ideal place to extend my research with the strengths in our Department of Medical Imaging and the expansion of using MRI in stroke,” she said. “And on the disparities side, it’s the ideal place to start looking at ways to reduce disparities in the Hispanic population.”

Her current research includes leading the MRI imaging core for a multi-center, NIH-funded study of racial and ethnic genetic variations in intracerebral hemorrhage (ERICH). The core uses multimodal imaging techniques to evaluate the impact of microbleeds, white-matter disease and other findings on stroke outcomes in patients with primary intracerebral hemorrhage.

Her disparities research is in collaboration with colleagues at Georgetown, where she began looking at health literacy and disparities in African-Americans. Like Hispanics, they score lower on health literacy than non-Hispanic whites.

A pilot study with Georgetown gives participants tablet computers, which record daily blood pressure measures, provide medication reminders, and play educational videos. The overall goal is to see if this approach improves blood pressure control, and increases medication compliance and ability to recognize stroke warnings signs.

“Health illiteracy is a huge problem, not just confined to stroke, but for most chronic diseases,” Dr. Kidwell said. “What we hope to show is that we can use technology approaches to teach underserved populations not only to recognize the warning signs of stroke, but to know the risk factors as well.”

By Jane Erikson

Photo: Much of Dr. Kidwell's MR imaging work has focused on understanding the pathophysiology of stroke, and using that information to guide therapy. In this example of a patient with an acute ischemic stroke in the right middle cerebral artery territory, there is only a small region of infarct (arrow on diffusion-weighted image (DWI) on the left, with a large region of decreased blood flow (Tmax perfusion map in middle) and evidence of a clot in the right middle cerebral artery (arrow, MR angiogram on far right). The imaging findings demonstrate a patient with a large region of salvageable penumbral tissue (diffusion-perfusion mismatch) who would be a good candidate for early endovascular therapy with a stent retriever device.