Article from: Winter - 2020



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    By Kristin Rattini

    A Look Back: Building a Cutting Edge Interventional Neuroradiology Service from the Ground Up

    DeWitte T. Cross III, MD

    Above: Interventional neuroradiologist DeWitte T. Cross III, MD, retired in June following a 30-year career in radiology at MIR.

    DeWitte T. Cross III, MD, professor emeritus of radiology, describes himself as a tinkerer. “I like to build things, fix things, work on new things.”

    Cross arrived at MIR in 1991 to establish the inter-ventional neuroradiology (INR) service. By collaborating closely with colleagues in neuroradiology, neurology and neurosurgery, incorporating the newest techniques and technologies in standard practice, and nurturing talented residents and fellows, Cross kept the INR service at the forefront of a rapidly evolving field.

    Early Years

    During his rotations in medical school at the University of Alabama-Birmingham (UAB), Cross found his path repeatedly leading to the radiology department.

    “At the time, the UAB radiology department was one of the best in the country,” he says. “The people who ran its various divisions wrote the standard textbooks that were used in residencies across the country, so no matter what rotation I was on — pulmonary, neurology — we would trot down to the radiology department and ask the radiologists to give us the answer of what was going on with a patient.”

    DeWitte T. Cross III, MD Above: A procedure snapshot of Cross

    DeWitte T. Cross III, MD Above: Cross completed residency at the National Naval Medical Center

    After attending medical school on a Navy Health Professions scholarship, completing a medicine residency in San Diego and experiencing some shipboard duty, Cross went on to a residency in diagnostic radiology at the National Naval Medical Center in Bethesda, Maryland. “There were no fellows there at the time, so residents got to do more than usual,” he says. During what was called specials rotation, Cross met Zelig Weinstein, an instructor he credits with solidifying his interest in neuroradiology.

    Following his residency, he spent two years as head of radiology at a naval hospital in Memphis. “The Navy gave me more responsibility earlier on in my career than one would get ordinarily.”

    From there his path led to New York City, where his wife, Anne H. Cross, MD, professor of neurology, had accepted a fellowship. He completed two fellowships, the second in diagnostic and interventional neuroradiology under Sadek Hilal, MD, at Columbia University. A pioneer in interventional radiology, Hilal invented the first microcoil to be introduced through a microcatheter for the treatment of a cerebral aneurysm.

    MIR Accomplishments

    Washington University landed on Cross’ radar after Anne was invited to give a talk. She returned home impressed by what she’d seen. “She told me, ‘You should call them up and see if they’re interested in having an interventional neuroradiologist,’” he recalls. He did; they were. Anne also secured a position in the neurology department.

    “Washington University struck us as a very collaborative environment. It was different than the New York experience, where people were competitive,” says Cross. “Here, people were of a high caliber and much more collegial, cooperative and collaborative; that appealed to us.” Once in his post, Cross advanced that spirit of collegiality by establishing a weekly vascular conference together with Ralph G. Dacey Jr., MD, then-chairman of neurosurgery.

    “It brought together residents, fellows and the attendings from neuroradiology, neurology and neurosurgery so that everyone could learn from each other,” says Christopher J. Moran, MD, professor of radiology and neurological surgery. “Cross was smart enough to know that we needed to work together, and he did it seamlessly.”

    DeWitte T. Cross III, MD

    Above: Cross with Christopher J. Moran, MD and Akash P. Kansagra, MD, examining a study

    Moran became one of Cross’ earliest and most frequent collaborators. They were kindred spirits, both enthusiastic and interested in all things new in their fields. “He helped bring medical-grade glue into treatment,” Moran says. “He was one of the first to use coils and balloons in the treatment of aneurysms. He took me to UAB to learn carotid angioplasty and stenting. Cardiologists were doing it, but he became one of the first neuroradiologists to do it.”

    As director of interventional neuroradiology for Barnes-Jewish Hospital and St. Louis Children’s Hospital, Cross put those cutting-edge techniques to work for patients of all ages. He developed innovative intra-arterial approaches for delivering medication to shrink congenital vascular malformations in children. “He always shared his technique and approach with all of us,” Moran says. “He didn’t want the spotlight on him. He’d say, “This is what we do as a group.”

    Cross is especially proud of his work in advancing stroke intervention. “When I came here, there wasn’t any stroke intervention going on,” he says. “The neurology community at the time fought us tooth and nail on it.” Cross conducted research that showed the efficacy of clot-dissolving drugs delivered intra-arterially and of thrombolysis in the basilar artery. “He provided level 1 evidence that it would work and that it benefitted patients,” Moran says. “He wasn’t a catheter cowboy about it. He had a thoughtful, reasoned approach.”

    DeWitte T. Cross III, MD Above: Cross and Ralph G. Dacey Jr. MD

    DeWitte T. Cross III, MD Above: Cross with his wife Anne H. Cross, MD, on vacation in Venice, Italy

    Cross has always considered teaching to be the best part of his job. He and Moran established the INR fellowship in 1994 and have trained some 40 fellows and even more residents. “It’s fun to meet these young people who are gaining skills, knowledge and maturity through your teaching and guidance,” Cross says.

    Cross retired in June as in awe of his specialty as when he first entered it. “The interventional neuroradiology field has gone through a remarkable transformation,” he says. “This evolution has made things better not only for the patients but for us practitioners as well.”