Babak Navi

5 Questions With Dr. Babak Navi

How researching stroke in cancer patients is creating new treatment paradigms

Babak Navi

For Dr. Babak Navi, it was both the fast-paced and immediate nature of stroke care as well as the ability to have a longer-term impact on patients’ quality of life that attracted him to the field.

“The acute treatment of stroke is very intense and rapid and exciting, which you don’t get in a lot of specialties,” says Dr. Navi, Division Chief of Stroke and Hospital Neurology at NewYork-Presbyterian/Weill Cornell Medicine. “But then there is the outpatient ambulatory part, which is more about developing a long-term relationship with the patient and treating them throughout their lifespan to preserve their brain health.”

Dr. Navi is working to shift paradigms on both ends of that spectrum. He has been involved in multidisciplinary efforts to expedite acute stroke treatment times; he’s the acting medical director of NewYork-Presbyterian’s mobile stroke unit, the first emergency vehicle of its kind on the East Coast; he helped launch an outpatient clinic to treat minor and non-disabling stroke; and he is a pioneer in studying the connection between cancer and stroke and potential blood-thinning strategies for this unique patient population.

Dr. Navi sat down with NYP Advances to discuss the various projects he’s been involved with and their impact on stroke treatment.

What sparked your interest in researching the connection between cancer and stroke?

What drew my interest was a single patient whom I treated as a junior resident who presented with recurrent ischemic strokes. It was a mystery initially as to what was causing them, and then we figured out that she had occult lung cancer, which was making her blood thicker. Once we figured that out, we treated her with chemotherapy and the strokes stopped.

That demonstrated to me that there’s this whole area where little is known, even as stroke in cancer patients has become more common. The co-prevalence of stroke and cancer has been increasing in absolute terms by about 0.3% per year over the past few decades because people with cancer are living longer. That led me to design studies to determine the epidemiological link between the two.

We now have phase 3 clinical trial data demonstrating that because of fast treatment times and other factors, mobile units are more effective than standard ED care in treating strokes.

We were able to demonstrate that in the few months before a cancer is diagnosed, at the time of diagnosis, and the six months after diagnosis, there's a tremendously increased risk of stroke — probably at least a twofold increased risk for most cancers. We’ve been able to show some of the pathophysiological underpinnings that make people with cancer have an increased risk for stroke, which gives us better targets to figure out the best blood-thinning strategy for them.

How does the knowledge you’ve gained through your cancer and stroke research have a practical implication for treatment?

Until recently, if a cancer patient had a stroke, there wouldn’t be much crosstalk between the oncologists and neurologists providing treatment. We were very siloed. But I think my work has shown that these two diseases are very intertwined and has demonstrated the need to have a partnership and close communication, because these patients are at a higher risk for second stroke and other neurological complications.

The oncologist is still the one driving the treatment plan for the cancer, but I think the neurologist needs to be involved in treatment decisions as well because the most effective strategy to prevent a second or recurrent stroke in someone with cancer is to treat the cancer and get it under control. Some oncological agents are also associated with an increased risk of stroke, which means you have to be mindful of the global risks when choosing a treatment. So now there’s often a closer discussion between the neurologist and the oncologist; it’s a nice collaboration and really in the best interest of the patient.

What other initiatives have you been involved with to improve neurological care, and can you share any results on this work?

From an acute treatment point of view, we created a streamlined protocol to rapidly transfer patients with suspected large vessel occlusion strokes from non-thrombectomy centers to our hospital for thrombectomy, which led to considerably faster treatment times. We’ve also greatly reduced our door-to-needle times for intravenous thrombolysis through lots of training of neurology house staff, emergency department house staff and faculty, emergency department nursing, and other stakeholders. When I was a resident 15 to 20 years ago, the average door-to-needle times were about 100 minutes. Now, they're about 35 minutes.

Getting lost in a book is a good way to reset my mind. Many of my best research ideas came to me when I was reading for pleasure and not focused on work.

Our mobile stroke unit has also been instrumental in improving acute stroke care, and we’ve participated in pivotal national trials showing their benefit. We now have phase 3 clinical trial data demonstrating that because of fast treatment times and other factors, they’re more effective than standard ED care in treating strokes. Since the inception of the program in 2016, we’ve treated around 300 people with clot-busting drugs.

For secondary prevention, we created a novel RESCUE-TIA clinic for patients who have a non-disabling transient ischemic attack or minor stroke, and who aren’t eligible for clot-busting drugs or thrombectomy and don’t have any therapy needs. Basically, in 24 to 48 hours, we can see them as an outpatient and get an MRI, look at their blood vessels, get important bloodwork done, and start them on appropriate secondary stroke prevention medications, such as blood thinners and cholesterol-lowering drugs, to prevent a second attack. There are very few programs like ours in the country.

Do you have any passions outside of work that help fuel you as a physician?

My biggest personal hobby outside of work is reading, which might sound funny since I read a lot for work. But I like to read novels, autobiographies, historical stories. My favorite novel is Catch 22 by Joseph Heller, and I’m a big fan of anything by Ernest Hemingway. Getting lost in a book is a good way to reset my mind and allows me to get outside of myself. Sometimes when you’re distracted, calm and relaxed, that’s when the ideas pop into your head. Many of my best research ideas came to me when I was reading for pleasure and not focused on work.

Reading also allows me to be a better doctor because I can empathize better with patients. Science writing by nature can be very non-emotional. Reading literature connects you to humanity. It allows you to put yourself in other people’s shoes and connect with them on a more emotional level.

You were a resident at NewYork-Presbyterian/Weill Cornell Medicine and returned as faculty in 2011. What brought you back to continue your career here?

My early rotations in neurology are what solidified my interest in stroke. I enjoyed helping people from all walks of life, all ages, and all backgrounds, with a mix of inpatient and outpatient. But I think the culture is what really sets NewYork-Presbyterian/Weill Cornell Medicine apart from other institutions. It does have all the resources and opportunities, but it's also very open about its desire for growth and change, and it enables that change to happen in a very collaborative and collegial way.

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