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Focus on Colin Derdeyn, MD

Colin Derdeyn, MD, is a professor of radiology in the division of diagnostic radiology, and a professor of neurology and neurological surgery. He is a specialist in endovascular surgical neuroradiology and a key member of the Washington University/Barnes-Jewish Hospital stroke and cerebral vascular team.

Dr. Derdeyn calls himself a brain plumber. If a blood vessel is closed, he can open it with a stent or balloon. If it’s open, like an aneurysm, he can close it. His area of specialty is interventional neuroradiology, which includes the treatment of brain aneurysms, arteriovenous malformations, stroke, and moyamoya disease.

Patients are seen at the Neuroscience Center in the Center for Advanced Medicine, 4921 Parkview Place, 6th floor, Suite C.

PLEASE CALL 314-362-3577 FOR AN APPOINTMENT.

What happened in the course of schooling to influence you to choose your specialty?

The brain always fascinated me -- I knew I wanted to do something in the clinical neurosciences and I liked to work with my hands. I started out in neurosurgery for those reasons. I liked the immediate results and the direct interaction with patients and their families. During my neurosurgery training in the late 1980s, the specialty of working inside the blood vessels inside the head, interventional neuroradiology, was just starting to blossom. It seemed like something that was going to be really exciting and important. Back then, the only route into that specialty was through radiology, so I switched to radiology to pursue training.
Dr. Colin Derdeyn and his family

Did you have a mentor that influenced you along the way?

I’ve been really fortunate in having a several outstanding mentors. The first was Dr. John Jane, chair of neurosurgery at the University of Virginia. I worked in his lab while in college and helped with clinical research in the department while in medical school there. He is a great example of the three-legged stool in academics: high level clinical practice, high level research and a wonderful training program. He set a great example and is someone I have tried to emulate.

Dr. Ralph Dacey (current Washington University chairman of neurological surgery) was my chairman at University of North Carolina (UNC). He helped me pursue training in this specialty at several steps along the way. . He has been a great example as well, and has developed a productive, multi-disciplinary group for the treatment of patients with complex diseases of the brain vascular system. It has been a real privilege to be a part of this outstanding team.

When I was looking for more specialized training in stroke-related research, I was given the opportunity to do a research fellowship with Dr. Bill Powers at UNC. He has since moved on to become the chair of neurology there. Bill taught me an enormous amount about brain physiology, stroke neurology, and research. He has a unique ability to find testable hypotheses in complex and clinically relevant situations. He was also very generous with his time and his door was always open. I learned most of what I know about writing papers and grant applications from Bill.

I have also had the benefit of great support and leadership from the past and present chairmen of the Mallinckrodt Institute of Radiology, Dr. Ron Evens and Dr. Gil Jost, respectively. They both gave me the freedom and support to pursue an unorthodox pathway in academic radiology. I am very grateful to both of them
 
What brought you to Washington University?

The opportunity to train at Mallinckrodt Institute of Radiology brought me here. It’s the best radiology training program in the country.

I came for the training, but stayed because I was able to have a very focused, high level practice and also be involved in important research.

The Barnes-Jewish Hospital/ Washington University relationship is unique in the country. I don’t think a lot of people recognize this -- except for those of us who work here. It is very unusual to have a full service private hospital, where medicine can be practiced at the highest level, combined with a major academic institution that has an outstanding research program.

On the personal side of it, it’s very hard to find a city that is this comfortable, with as many good neighborhoods and schools for raising a family. St. Louis has all those qualities -- it is a great place to live and raise a family
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Which aspect of your practice is most interesting?

Interactions with patients and their families are the most compelling and immediately satisfying. I also enjoy supervising residents and fellows, and moving research forward
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What new developments in your field are you excited about?

Interventional neuroradiology has only been around for twenty years and has evolved quickly in that time. Over that period, we have seen the treatment of patients with brain aneurysms evolve from a time when the only treatment was open surgery, to now where most patients are treated with a small incision in the groin and placement of coils in the aneurysm from inside the blood vessels. The field is totally device driven, every year there are new and better devices that come along. It’s all about the instruments and the tools that we use to fix a problem from inside the blood vessel.

Brain plumber is my ‘cocktail party’ description of what I do is. If it’s closed, I can open a blood vessel with a stent or balloon. If it’s open, like an aneurysm, I can close it. There are all kinds of devices to plug a hole, and every year there are more and better devices. It’s an exciting place to be because of all the innovations and improvements in technology. There is a lot of potential to help people.

One of your areas of clinical interest has a very interesting name. What is moyamoya?

Moyamoya (Japanese for “puff of smoke”) is an uncommon blood vessel disorder in which the ring of blood vessels at the base of the brain progressively narrows, causing blood flow to the brain to become blocked. It usually affects women in their 20s and 30s and can cause stroke. It’s an unusual disease that causes a lot of disability, unfortunately we know very little about it.

I developed the Washington University moyamoya center, in partnership with colleagues in Neurosurgery, because I had some tools, primarily through my stroke research fellowship, to monitor the blood supply to the brain. The best treatment right now is open surgical bypass. We have one of the largest centers for this condition in the country now.

What tools do you have in your tool box?

The biggest part of my practice is treating brain aneurysms – which are little weaknesses in the wall of an artery than can rupture. We guide a very small tube from the groin until the tip of it is inside the aneurysm. We fill the aneurysm with soft platinum coils or other material to prevent it from rupturing. We still use open clipping for some patients – opening the skull and pinching the aneurysm shut. But for probably two-thirds of our patients, we are able to take care of the weakness from inside the blood vessels.

For patients who suddenly develop weakness of an arm or leg due to acute stroke (from a blood clot that’s plugging up an artery), there is definitely a role for an inside-the-blood vessel treatment to dissolve the clot or pull it out. There is great potential in this area and a lot of my research is concentrated here because there is a group of people who don’t do very well with the existing treatments for stroke.

More than half of the stroke patients who are treated with intravenous tPa, the blood clot dissolving drug, do not do well. This is still much better than if they weren’t treated at all, but there is a lot to be gained in this field.

Stroke is caused by so many different factors. There are a small fraction of stroke patients who end up coming here for inside-the-blood vessel treatment. Finding the ones that need this kind of intervention is a big part of our effort.

How are stroke centers helping with the advancement of stroke care?

There are a lot of factors driving centralization of stroke care and this is occupying a lot of my time. We have large comprehensive stroke centers that can take care of patients with ruptured aneurysms, acute stroke, and patients where the stroke is due to bleeding in the brain (not a blocked artery).

These centers serve as a hub so regional medical centers can quickly diagnose and send patients to the stroke centers for timely treatment. There is state legislation – similar to what created trauma centers – that’s driving this.

I’m the center director here at Washington University and it’s important to develop relationships with community hospitals -- having our emergency room (ER) physicians make connections with neurologists and community ERs to make sure patients at these small hospitals are well cared for, as well.

Where are you from?

I grew up in Charlottesville, Virginia, a small university town. My father was a child psychiatrist on the faculty at University of Virginia (UVA). I went to college and medical school there.

My wife is from St. Louis and we met when we were undergraduates at UVA. We were married during my residency in neurosurgery in Chapel Hill. It was by chance that we ended up back here at Washington University -- things worked out well.

Your middle name is spelled Pieter, is that a family name?

That’s my grandfather’s name. He grew up on one of those barges on the Rhine River. You might have seen pictures from the 1920s where the entire family lives on the barge and their laundry is hanging out on a line on the back of the boat. His father, my great grandfather, piloted the barge up and down the Rhine. My grandfather was very bright, but with limited means. He started working in the mailroom of Phillips, the Dutch electronics company, and worked his way up to become their chief financial officer. He was a remarkable man.

Is there a particular award or achievement that is most gratifying?

I can think of two professional achievements that are very gratifying. The first was when I was elected president of the Society for NeuroInterventional Surgery – the medical society for the specialty of interventional neuroradiology.

The society has evolved over the last 20 years, allowing physicians from multiple backgrounds to get into fellowship training. Half of the physicians in the United States that are practicing this specialty are endovascular trained neurosurgeons or neurologists -- it is a big tent for all fellowship-trained physicians. I think I helped move it towards the multi-specialty orientation.

The second was when we received the news that our application for an NIH-funded translational stroke research center had been successful. This was a multi-departmental collaboration built on a longstanding legacy within neurosurgery, neurology, emergency medicine and radiology. We have built on this platform, with the support of the medical school and Barnes-Jewish Hospital, to develop the Stroke and Cerebrovascaular Center.

What is the best advice you’ve ever received?

I’ve had great examples to follow, but I don’t recall any specific words of advice. My personal favorite for my children is the line from the book of Luke – to whom much is given much is expected.

If you weren’t a doctor what would you like to be doing?

Anything outside -- probably a guide for outdoor adventures like rafting or kayaking.

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