Michael F Waters, MD

Michael F. Waters, MD, PhD, is the Systemwide Director of the Neurovascular Division and a professor in the Department of Neurology at Mount Sinai School of Medicine, consistently ranked as a top hospital in neurology and neurosurgery. He is board-certified in Neurology by the American Board of Psychiatry and Neurology with subspecialty board certification in Vascular Neurology.

Dr. Waters' expertise includes stroke and neurovascular disease, encompassing signs, symptoms, diagnostics, and treatments. He is a Fellow of both the American Academy of Neurology and the American Heart Association, and a member of the American Neurological Association, the American Society of Human Genetics, and the Society of Vascular and Interventional Neurology. Dr. Waters received his master's degree in genetics from Penn State and his doctorate in biochemistry and molecular biology, along with his medical degree, from The University of Florida College of Medicine. He completed his residency training at the UCLA Department of Neurology and a fellowship in Clinical and Molecular Neurogenetics at Cedars Sinai Medical Center in Los Angeles. Dr. Waters' research focuses on vascular dementia in stroke, genetic mechanisms of stroke, neuroprotection in stroke, multiple clinical trials investigating stroke treatments, and neurogenetic mechanisms of neuroplasticity and neurodegeneration.

Following the completion of his fellowship in 2005, Dr. Waters has dedicated his clinical focus to treating stroke. This includes faculty appointments in vascular neurology at UCLA, Cedars Sinai Medical Center, the University of Florida College of Medicine, and the Barrow Neurological Institute. In these positions, he has overseen portfolios of clinical trials related to vascular neurology, including participation as an NIH/NINDS StrokeNet regional coordinating center. Additionally, he leads an 800-square-foot molecular biology lab with shared space that includes a vivarium with a behavior core, tissue culture facilities, animal imaging (MRI, U/S, PET), and a microsurgical suite for performing stroke model experiments. His translational research team comprises PhD scientists, technicians, and graduate students.

Dr. Waters' research stems from a keen interest in neuroinflammation and neuroprotection following stroke. His ability to collaborate productively and bridge basic, translational, and clinical science fosters progress in research. During his clinical activities, he witnesses firsthand the lost opportunities for intervening in acute stroke care with therapies that could mitigate or ameliorate the inflammatory and degenerative processes that persist long after the hyper-acute phase of stroke, phenomena that contribute substantially to resultant impairment and vascular dementia. He is frequently challenged by the limited therapeutic options facing his patient population and constantly seeks expanded opportunities to offer effective treatments. His goal is to contribute to the development of therapeutic options and expand the currently limited treatments, which are curtailed by both efficacy and timing constraints. He aims for treatments targeting underlying pathologies beyond current strategies, particularly micro thromboses, small vessel hypoperfusion, and microinfarcts. These phenomena are exacerbated by the sterile neuroinflammatory milieu propagated by the immune system. Mitigating this cause of microinfarcts, known to lead to vascular cognitive impairment and dementia, is the focus of his current research.

Throughout his scientific career, Dr. Waters has been involved in practice-changing national and international clinical trials, most often as a site PI. At the University of Florida, he directed one of the lead recruiting sites for the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) trial, designed to define the preferred treatment for patients with symptomatic intracranial atherosclerotic disease. The results of this trial led to international guidelines supporting maximum medical management as superior to stenting in this patient population. More recent trial participation includes the practice-defining recommendation of transcranial Doppler as superior to transthoracic echocardiogram in identifying PFOs in patients with embolic strokes of unknown etiology. Currently, he is the site PI for the Determinants of Incident Stroke Cognitive Outcomes and Vascular Effects on Recovery (DISCOVERY) trial, which aims to gain valuable insight into the increasingly recognized phenomenon of vascular cognitive impairment and dementia as a leading and devastating disability in stroke populations.

Vascular dementia has long been identified as one of the most common causes of dementia in the aging population. The multifaceted etiologies and lack of a central theme have hampered progress in understanding and combating this disease. Dr. Waters is currently involved in the 30-center NIH-funded DISCOVERY trial in pursuit of answers defining vascular features contributing to cognitive impairment in stroke. Increasing data supports microvascular disease and hypoperfusion as key contributors. His observations and research in this area have strengthened his belief that progress can be made to lessen the impact of microvascular hypoperfusion as a risk factor for vascular dementia in stroke patients. This is clearly seen in patients who undergo recanalization of large vessel occlusions (LVO) but do not reap the expected benefits of this restorative therapy. Understanding the mechanisms and developing mitigating strategies to restore microvascular perfusion will complement LVO recanalization and extend the benefits of interventional acute therapies.