A framed watercolor hangs on an operating room wall in Tampa General Hospital, depicting an average day in the angiography suite. The painter may not be a famous artist, but he’s well known within TGH and the USF Health Morsani College of Medicine — Maxim Mokin, MD, PhD, a vascular and interventional neurologist whose hands not only create evocative artwork but are integrally entwined in cutting-edge stroke research and patient care.
With stroke a leading cause of long-term disability in the United States, Dr. Mokin and his team are on the front lines in the search for effective treatments and greater understanding of the life-threatening and potentially fatal condition. Strokes occur when blood flow to the brain is interrupted, either by a blood-vessel blockage (an ischemic stroke) or bursting (a hemorrhagic stroke). The resulting deprivation of oxygen and nutrients can cause serious and possibly permanent damage.
“I think you’ve heard the statement, ‘Time is brain,’” said Dr. Mokin, professor of Neurosurgery, Brain and Spine in the USF Health Morsani College of Medicine. “What that really means is that if you’re trying to do something for the brain to preserve it from having more damage, every second counts,” he said. “And a lot of research that we perform in the ‘angio’ suite — that’s where I primarily work as a neuro-interventionalist — is to make these interventions as safe and effective as possible.”
USF Health and TGH neurology and neurosurgery faculty physicians are among the busiest clinical research trial sites in the U.S. for acute stroke management and treatment. Dr. Mokin, who also is vice chair of research for the Neurosurgery department, as well as director of USF’s Center of Excellence for Aging and Brain Repair, and his team are currently helping to 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.
“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,” Dr. Mokin said on a recent morning in Tampa General’s large Neurosciences Intensive Care Unit.
Dr. Maxim Mokin also paints watercolors of his colleagues at work.
Those state-of-the-art tools are essentially catheters, slender tubes that allow doctors to open up vessels to treat occlusions more effectively and quickly, when time is of the essence. By pioneering the use of the latest catheter technologies, Dr. Mokin and his team ensure that patients receive fast, effective treatments that minimize brain damage and maximize recovery.
In fact, USF Health and TGH were 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 a Zoom 88 Large Distal Platform, a group of catheters manufactured by Imperative Care. The Zoom catheters are highly flexible, allowing it 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, Dr. Mokin explained. The study enrolled 262 patients from some 30 sites in the U.S. and included investigators in various specialties from Emory University, the University of Southern California and Mount Sinai Hospital in New York City, with Dr. Mokin serving as principal investigator for USF Health/TGH.
“These catheters are now used by many physicians in the United States,” Dr. 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 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.”
Clot removal underwent its first major advancement some 20 years ago, thanks to physicians at UCLA, Dr. Mokin said, with the introduction of a corkscrew device to remove clots. That was followed by another breakthrough: retrievable stents, mesh-like tubes that can be inserted into blood vessels and travel via catheters to the site of a blood clot. The stent is then used to catch, retrieve and then remove the clot.
These days, more and more stroke procedures rely on aspiration, where the clot is directly suctioned out. This is what the Imperative trial and other USF Health/TGH trials are focused on.
In addition to clinical investigations, Dr. Mokin’s team has several research projects that are federally funded and supported by NIH grants and are geared 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.
Although hemorrhagic strokes are less common than ischemic ones, they often are more deadly. Dr. 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 in May 2024, suggested by an old college friend who spent his career there.
Tampa artist Charles Greacen had a potentially deadly brain aneurysm treated by Dr. Mokin.
“The test looks for certain markers related to early onset dementia,” Greacen explained. “So my wife and I did this very thorough check-up, where they monitor your brain while you sleep. And the clinic said, ‘If we find anything wrong we’ll notify you.’ And sure enough they did.”
It wasn’t the news Greacen expected or wanted to hear. 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. They decided to follow up after returning home to Tampa, where friends recommended he go see Dr. Mokin. He received the same advice from someone at the Cleveland Clinic: “He told me, ‘If you’re not going to get it taken care of here, let me recommend a name to you — Dr. Mokin at Tampa General Hospital.’”
Dr. Mokin and his team did the 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.”
Dr. Mokin is now exploring a promising new direction for his research called neuro-protection — exploring 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, Dr. Mokin embraces the escape and relaxation offered by painting, 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.
Dr. Mokin sees a connection between his creative pursuit and his medical work on the stroke frontier.
“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.”
In the field of stroke research and patient care, Mokin is a true artist.
— Video and photo by Ryan Rossy, USF Health News; artwork courtesy of Dr. Maxim Mokin