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Paul Tunick, M.D.

Dr. Tunick's major research interest has been the investigation of causes of stroke and peripheral embolization, particularly those involving atherosclerotic disease of the thoracic aorta. In 1990 he described the first stroke patients with a new finding on transesophageal echocardiography: severe atherosclerotic plaque in the aortic arch. After a case-control study demonstrated a very significant association of severe aortic plaque on TEE and emboli, a prospective study followed which showed that the risk of future stroke or TIA is 12% in a year, and 33% of patients had cerebral or peripheral embolization. The group of patients undergoing surgery with cardiopulmonary bypass is at especially high risk, as cannulation of the aorta may result in the dislodging of atherosclerotic material and thrombi from the aortic arch. A prospective study in the operating room showed that these atheromas are an important cause of stroke due to cannulation of the aortic arch during heart surgery. A subsequent study of 268 patients with aortic arch atheromas showed a very high risk of intraoperative stroke (approximately 12%, or 6 times higher than the average intraoperative stroke rate during cardiac surgery). This study also showed that arch endarterctomy, designed to try to prevent stroke, actually increases the risk. Recently Dr. Tunick completed a retrospective study of 519 patients with severe aortic plaque on TEE. The risk of future embolization to the brain or periphery was significantly reduced in those patients who were given statins. However, no effect was seen with the use of warfarin or antiplatelet therapy. Current projects assessment of percutaneous mitral valve repair (EVALVE); Longitudinal study of aortic arch plaque on TEE; Carotid IMT in CHF, DCM; Evaluation of chest pain in the ER with Tissue Doppler; Correlations of echo and MRI in the evaluation of mitral regurgitation using a novel, high-temporal resolution phase contrast MRI technique; Correlations of echo and MRI in the evaluation of mitral regurgitation.

Selected Publications:

  1. Kronzon I. Tunick PA. Aortic atherosclerotic disease and stroke. Circulation 2006;114:63-75.
  2. Tunick PA, Kronzon, I. Protruding Atherosclerotic Plaque in the Aortic Arch of Patients with Systemic Embolization: A New Finding Seen by Transesophageal Echocardiography. American Heart Journal, 120:658-660, 1990.
  3. Tunick PA, Culliford A, Lamparello, P, Kronzon I. Atheromatosis of the Aortic Arch as an Occult Source of Multiple Systemic Emboli. Annals of Internal Medicine, 114:391-392, 1991.
  4. Tunick PA, Perez JL, Kronzon I. Protruding Atheromas in the Thoracic Aorta and Systemic Embolization. Annals of Internal Medicine, 115:423-7, 1991.
  5. Tunick PA, Lackner H, Katz ES, Culliford AT, Kronzon I. Multiple Emboli From A Large Aortic Arch Thrombus In A Patient With Thrombotic Diathesis. American Heart Journal, 124:239-41, 1992.
  6. Tunick PA, Katz ES, Freedberg RS, Rosenzweig BP, Perez JL, Kronzon I. High Risk for Vascular Events in Patients with Protruding Aortic Atheromas: A Prospective Study. Journal of the American College of Cardiology, 23:1085-90, 1994.
  7. Paz R, Jortner R, Tunick PA, Sklarovsky S, Eilat B, Perez JL, Kronzon I. The Effect of Ethanol on Obstruction of the Left Ventricular Outflow Tract in Hypertrophic Cardiomyopathy. New England Journal of Medicine, 335:938-41, 1996.
  8. Selker H, Zelinski R (co-chairs), Tunick PA, et al. An Evaluation of Technologies for Identifying Acute Cardiac Ischemia in the Emergency Department: Executive Summary of a National Heart Attack Alert Program Working Group Report Annals of Emergency Medicine, 29:1-12, 1997.
  9. Stern A, Tunick PA, Culliford AT, Lachmann J, Baumann FG, Kanchuger M, Marschall K, Shah A, Grossi E, Kronzon I. Protruding Aortic Arch Atheromas: Risk of Stroke During Heart Surgery with and without Aortic Arch Endarterectomy. American Heart Journal, 138:746-52, 1999.
  10. Tunick PA, Kronzon I. Atheromas of the Thoracic Aorta: Clinical and Therapeutic Update. Journal of the American College of Cardiology, 35:545-554, 2000.
  11. Tunick PA, Nayar AC, Goodkin GM, Mirchandani S, Francescone S, Rosenzweig BP, Freedberg RS, Katz ES, Applebaum RM, Kronzon I, for the NYU Atheroma Group. Effect of Treatment on the Incidence of Stroke and other Emboli in 519 Patients with Severe Thoracic Aortic Plaque. American Journal of Cardiology 90:1320-5, 2002.
  12. Tunick PA, Kronzon I. Atheroembolism (Chapter 51) in Vascular Medicine. A Companion to Braunwald’s Heart Disease. Creager M, Loscalzo J, editors, 2005. (Book Chapter)
  13. Tunick PA. Embolism from Aortic Plaque: Atheroembolism and Thromboembolism. Published online (with Figures and Videos): http://www.uptodate.com, 2005.
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