Researchers at the University of Utah and other institutions have created a prospective registry of patients with traumatic brain injuries (TBIs) and collected data from pre-hospital, in-hospital, radiology, follow-up, and other reports to create a repository with more than 3000 patients with thousands of data points. Ramesh Grandhi, MD, a neurosurgeon with clinical and research
interests in neurotrauma and cerebrovascular pathology and the unique combination of the two, is the site primary investigator in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) research initiative at the University of Utah Health. He collaborates with investigators at other institutions involved in the initiative, including Administrative Core Leader Geoffrey Manley, MD, PhD. “During my residency at the University of Pittsburgh, we were part of the TRACK-TBI pilot program, so it’s been great to have the full-circle moment of coming back to the larger initiative as a member of the steering committee and a site study leader,” Dr. Grandhi shared.
“A big part of the initiative’s draw for me,” Dr. Grandhi said, “is that it has become a clearing house for clinical trials, and we’re constantly evolving and taking on new projects.” That led to U.S. Food and Drug Administration (FDA) clearance in April 2024 of the portable i-STAT Alinity instrument from Abbott,
which allows providers to test whole blood at a remote location or at a patient’s bedside to determine whether a concussion has occurred by detecting proteins leaking from the brain into the bloodstream. “What’s incredible,” Dr. Grandhi said, “is that earlier devices took hours to run the tests, this one can do it all in 15 minutes as a point-of-care test. The FDA clearance of the new device will revolutionize the diagnosis of brain injuries and allow first responders to diagnose these injuries right at the scene.”
Dr. Grandhi is involved in many other TBI-related clinical trials, including the BOOST-3 trial, which compares the effectiveness of two different strategies for monitoring and treating patients with TBI. “There is still so much work to be done to inform care for patients with TBI. I look forward to seeing how we continue to develop over the next several years,” Dr. Grandhi shared.
Dr. Grandhi is also highly involved in pushing the boundaries of cerebrovascular care using minimally invasive, catheter-based interventions for patients with stroke and cerebrovascular disease. “Endovascular technologies and techniques have exploded in the last decade. We are now able to envision and offer endovascular approaches to patients with other pathologies that were not always thought of as
cerebrovascular, for instance, using the blood vessels for drug delivery in patients with brain cancer.”
“I’m also very interested in the combination of trauma and cerebrovascular, such as in patients with chronic subdural hematoma,” Dr. Grandhi said. “The recurrence rate of chronic subdural hematomas is high, especially in older populations. We have been super fortunate to participate in three randomized, controlled trials here at the University of Utah, which have truly changed how patients with this disease are treated. By finding better ways to care for these patients and minimize recurrence, we are definitely influencing medicine on a large scale.”
“We’ve got a few trials related to endovascular work in the pipeline that I’m really excited about,” Dr. Grandhi shared, “and I look forward to getting those underway here at the University of Utah, with my endovascular neurosurgery partners and the team in stroke neurology.” Participation in clinical trials can make a real difference
in the lives of patients. For instance, the Department recently received a financial donation after Dr. Grandhi removed an intracranial clot in a woman who presented with a significant stroke burden. This intervention was performed through the TESLA trial, a randomized, controlled trial investigating the safety and efficacy of endovascular clot extractions in patients with large core infarcts. “After just one month, this patient experienced a near total recovery,” Dr. Grandhi said. “Her husband was extremely grateful and wanted to encourage our team’s future research in this area. Thankfully, through the efforts of numerous collaborators, including our team, trials have demonstrated that patients with intracranial clots should be offered this life-changing procedure, which has now been adopted here at the University of Utah as well as nationally and internationally.”
Dr. Grandhi expects that there are many more amazing things in store. He sees endovascular care as a conduit for improving the care of patients with myriad neurologic pathologies. “More diseases will be treated using endovascular methods, and there will be increasing numbers of
trials to determine which pathologies and cases are better treated using endovascular strategies over the current treatment method. We’re just scraping the surface at this point,” he says. “I’m really excited for the future.”