Ellen Goldbaum: A member of USRowing's Under 19 National Team, Elad Levy figured he'd be a professional rower after college. His dad, an ob-gyn, suggested he get a medical degree as a backup. So he tried to do both.

Elad Levy: I'd come into class soaking wet at 8 o’clock in the morning because I was up rowing since 5 o’clock, and I was studying till 1 o’clock in the morning. But by my second year of medical school I came to my senses, and rowing had to be on the back burner.

Ellen Goldbaum: That summer, Levy got a scholarship to do research with the neurosurgery department and never looked back. Today, he's the L. Nelson Hopkins Chair of the Department of Neurosurgery at UB’s Jacobs School of Medicine and Biomedical Sciences, and enjoys a global reputation in the field of neurovascular disease. The principal investigator on several paradigm-shifting research studies, Levy has also co-authored more than 800 peer-reviewed publications and numerous books. He was instrumental in the establishment of thrombectomy, the surgical removal of a blood clot, as the standard of care for stroke, and was among the first surgeons to implant a brain-computer interface stent for people living with paralysis. He performs carotid artery stenting in an ambulatory surgery center, a major milestone for the field, and is currently developing a fully non-invasive approach to brain surgery.

Welcome to Driven to Discover, a University at Buffalo podcast that explores what inspires today's innovators. My name is Ellen Goldbaum, and in this episode, I'll be speaking with Dr. Levy about his relentless dedication to advancing the field of neurosurgery.

Dr. Levy, thank you for joining us.

Elad Levy: Thank you for having me.

Ellen Goldbaum: Before we get to neurosurgery though, let's talk about your early years. You were born in Israel, and then your family moved to Upstate New York?

Elad Levy: That's right, I moved at the age of six. My father was a professional soccer player, wanted to be a veterinarian, went to Italy hoping to go to vet school, but they said he wasn't good enough or smart enough, so they said, “Why don't you go to med school?” Eventually came to the United States, was hoping to be an orthopedic surgeon as a foreign-trained medical student, eventually found a residency in a community hospital as an ob-gyn surgeon. And then in the mid to late ’70s, we moved to northern New York, just south of the Canadian border by Cornwall.

Ellen Goldbaum: So that was a big change for you.

Elad Levy: That was a very big change.

Ellen Goldbaum: When was it that you discovered rowing?

Elad Levy: So, the county we grew up in, Franklin County, had one of the lowest college matriculation rates in the state of New York, and my parents certainly believed in education, so they sent me away to high school for the last two years, Choate Rosemary Hall. And when I went to Choate, they saw my size, I was a relatively tall and fit person, and they said, “Hey, why don't you think about rowing if you don't have another sport?” And it was sort of love at first sight, and I could put a lot of my passion into the rowing. It was the years of what I call bloody hands. I knew my ticket out of Upstate New York or northern New York, or potentially my ticket into the next level of education, was bloody hands. So, every day I would row till my hands bled, and I think that paid off.

Ellen Goldbaum: OK, so how did it pay off?

Elad Levy: So, academically, Choate was very challenging for me. English was really a second language at the time; I came from a rural Upstate New York education system into a hyper-competitive New England boarding school. So, certainly my grades were not at the top of the class, I had a lot of catching up to do. So, all my energy was in rowing, and eventually I was recruited to row at Dartmouth.

That was my outlet, that was my life, that was where I poured all my energies into. I had aspirations of going from the 19 Team to the next level and maybe even an Olympic team, a national team. But uh, which is also why I chose eventually to go to med school where there was competitive rowing, the Potomac Boat Club, where at that time, I also rode at U.S. Olympic fest [the U.S. Olympic Festival]. But rapidly I realized I didn't have the gear or the physiology or the size to make it to that next level.

Ellen Goldbaum: So you decided to lean into your studies.

Elad Levy: I applied to two summer fellowships between my first and second year, one was ortho sports, and the other one was neurosurgery as a backup. I did not get the ortho fellowship, but I did get the neurosurgery fellowship, and I was awestruck. At that point, I leaned all in—all that energy, all that passion that I sort of had for rowing, pivoted, and I decided neurosurgery was going to be my future. That is my passion, that is my sort of career, and that's when I leaned all in into neurosurgery.

Ellen Goldbaum: And why neurosurgery?

Elad Levy: I get that question a lot: “Why neurosurgery?” And I think the same holds true now that it did in the late ’90s, early 2000s. It’s sort of that last frontier of unknown of the human body, right? We really are only now exploring the intricacies of the brain. We're only now truly understanding that these regions that we thought were silent are not silent. We're just developing technologies now that we can instrument the brain in minimally invasive ways. So, for me, that was very exciting. It also had macro-surgery, meaning large bone removal, and micro-surgery, intricacies for bypass or clipping aneurysms. So I fell in love with that vascular part of neurosurgery.

Ellen Goldbaum: OK, so you went to Pittsburgh for residency, and then UB for fellowship. And while you were here, you were working under Dr. Hopkins. He was taking an unconventional approach to stroke treatments. What was the standard of care at the time? What was Hopkins proposing, and what made you think he was on the right track?

Elad Levy: So at the time when I was a resident at Pittsburgh, which was a top 3 volume shop in the country, and I wanted to do endovascular, they said there were only two places in the United States where they're going to let me train for endovascular. And one of them was Buffalo with Nick Hopkins.

He was changing the world. He was putting UB on the map because he was developing a transvascular, endovascular route for diseases that we typically have to open our head. He was going to go through the arteries or through the veins. And it was very novel. He was a pioneer. He established this field for neurosurgeons, unquestioned.

So it was 2001 when we had a patient come in with a stroke, and I'll never forget, it was a basilar artery stroke, non-survivable, and the patient didn't survive. And he turned around and looked at me, he said, “If the cardiologists can open coronary arteries in a heart attack, we can, and will, do the same for stroke.” And that's when everything switched. And for the next decade and a half, our focus, our energy, technology, dozens and dozens of papers and trials, were all focused on creating a new paradigm: moving stroke from the era of rehabilitation to intervention. No longer a disease of the ICU and medicine and “hope we can rehab you.” We are going to stop stroke in its tracks, we're going to reverse it, and you're going to walk out of the hospital.

Ellen Goldbaum: And that all happened starting at UB.

Elad Levy: That happened at UB in 2001 and certainly other centers. I talk about phases of acceptance, if I can share this amazing story. So, it's 2005, maybe 2004, I'm presenting at a national meeting, one of our first stroke cases. And I'm a young attending, I'm here at UB, I'm a young associate professor, and I'm on a main stage. My chest is up, my head is up, I'm feeling energized, and I show how we open up this artery and publish this case in a young woman, right?, 27, 28 years old, who had a stroke.

A chairman at a very prestigious Ivy League university stands up, and I think he's about to give me the biggest compliment of my life. And he says, “If I had a tomato, I would throw it at your face. You guys are cowboys, renegades and pariahs.” And then, of course, he's very famous, so everybody gloms on, and I wanted the ground to swallow me up right there, and I came back to Buffalo, just defeated. And Nick said, “If people weren't having a visceral reaction, you weren't doing anything worthwhile.” And that never left me. And he said, “Double down, dig in, we're going to do this.”

Fast forward a decade, 2015, New England Journal, SWIFT PRIME multinational trial, as well as some other trials. New standard of care—thrombectomy. Better than medicine. Patients who have a stroke within a certain time frame, standard of care: Take the clot out.

Ellen Goldbaum: And that's still the case.

Elad Levy: And that is 100% the case. And now, time is less of an issue, right? So, depending on the physiologic imaging, the time window is much larger than it was in 2015.

Ellen Goldbaum: So more recently, you've been playing a leading role in implanting the Stentrode, a brain-computer interface device that allows people with limited to no mobility to operate technology, like mobile devices and computers, using just their thoughts. How did you get involved with this and how is that going to change how patients with paralysis live?

Elad Levy: So, we were foundational in creating stroke as a standard of care, stroke intervention. But we can't just have a one-off, right? We don't want a No. 1 selling album once, right? We want to do this again. So, people recognized UB Neurosurgery as sort of the epicenter on the globe for endovascular therapeutics. “How do we get to the brain through the vessels?” So the Stentrode by Synchron, and there are other brain computer interfaces, as you know, Elon Musk with Neuralink, but this one goes through the veins. So they naturally reached out to us as one of the centers, as well as Pittsburgh, and I think Mount Sinai was the other one, and it was just a very natural marriage.

And to me, think about reconnecting a human with the world. So you're trapped in your body. You can't move. You probably can't speak well. You need people to ask you, “Do you want a glass of water?” “Do you need to go to the bathroom?” “Do you want me to take your wheelchair outside?” You're basically locked in. But now imagine we can outsource that to a peripheral. You can initiate conversation. “Please take me outside.” “Please open my window.” Next level: Using my thoughts, I can use my automatic dog feeder to feed my dog. Turn on the water automatically. Move a motorized wheelchair. Turn on a light. Communicate via talk to text—I can communicate a text, and it will read it out. “How are you doing today?” Imagine the freedom, or the humanity, you give back to someone who has ALS, Lou Gehrig's disease. To be on the ground floor, on the forefront? Of course we’d jump all over that.

Ellen Goldbaum: That's amazing. This past year, you started performing carotid stent surgeries in a specially designed outpatient center. These procedures increase blood flow to the brain when there's a blockage and are usually done in a hospital with an overnight stay. What are the advantages of performing them on an outpatient basis?

Elad Levy: That is a great question, Ellen. Let me ask this question back rhetorically. Who gets knees and hips done in a hospital today? Who gets MRIs and CAT scans in a hospital today, electively? Nobody. Ten years ago, joint replacement was all done in a hospital. Cataracts, before that, all in a hospital. Before that, scans all in the hospital. But they moved outpatient. Why? Ease of access for a patient, cost of care, decreasing the bottleneck in a hospital for major surgeries like liver transplant or large brain tumors or stroke. So this is a triple win, plus the care team, better well-being of the care team, quintuple win, and then access for the community. So why is neurosurgery that last subspecialty that has not embraced outpatient care? Ambulatory care?

So that is sort of my next passion now. Can we decrease the cost curve, increase satisfaction for patients, increase satisfaction for the physicians, and reduce the bottleneck and wait time in a hospital, so you're not waiting three months to get your carotid artery stented or your brain aneurysm endovascularly treated. So recently, we published the first series in the world of outpatient aneurysm treatment with flow diverters, published in the Journal of NeuroInterventional Surgery.

Ellen Goldbaum: You are currently working toward brain surgery that's not just minimally invasive, but non-invasive. Can you explain that?

Elad Levy: So, diseases like tremor, for example, or potentially Parkinson's, or other degenerative diseases of the brain. Typically, we can do invasive procedures like deep brain stimulation, but there is technology out there that some centers have called focused ultrasound, or other non-invasive energy, that we can use to create strategic lesions in the brain that can address these problems. So, at UB now we're trying to look at the different technologies, not just focused ultrasound but other technologies that are on the horizon in research trials, that can create different energy lesions in the brain to treat diseases like we talked about, the functional or degenerative diseases.

Ellen Goldbaum: Part of your job is to train others to do what you do. So tell me about some of your students. What are they doing now?

Elad Levy: We’ve trained some of the best fellows in endovascular neurosurgery across the globe. So, we have people, two people that I've trained are back in the Middle East. We have people that we've trained that are back in Asia. I've trained Peter Kan who now is a chairman, he did his fellowship with us. Alex Khalessi, who's now chair at UCSD. J Mocco, who's now chair at Cornell. And most recently, Rob Ecker, who's chair at a new program up in Maine. So, we are creating the thought leaders of the next generation, and several other fellows who I haven't mentioned that are program directors or division head directors.

Ellen Goldbaum: Now the million-dollar question: Do you still row?

Elad Levy: So, I love that question. So, Head of the Charles—one of the largest regattas in the world, right, in Boston every fall. So in 1992 we had four of us. It was me, Ted Murphy, who was a two-time Olympian at the time, Jeremy Howick, who is Canadian National Team, and Sawyer Hall, who probably could have been but didn't. We were setting a course record for colleges, and I think actually on pace with Team USA, where we hit the last bridge, coxswain couldn't make the turn.

Fast forward, 33 years later, we said, “We're going to put this boat back together, we're going to finish this race.” So, about a year and a half ago, we got our coach, our old coach from Dartmouth at the time, Scott Armstrong. He sent us the workouts. He's now coaching somewhere out in the Midwest, but we all kind of erged and trained, met back in Hanover for a week, trained with their team—obviously, we're not as fast as that college team, they're amazing—but we train twice a day in the boathouse to get our boat together and then finish that race. And I think we actually finished 11th, and if you finish top 15, you’re guaranteed a spot for next year. So, wasn't a bad finish, we wanted to crack top 10, but not bad for a bunch of 50-year-olds putting the boat back together.

Ellen Goldbaum: Great, great story. Thank you so much. This has been a real pleasure.

Elad Levy: This has been a lot of fun. Thank you for having me.