January 2014 Edition - Health Matters

NCH Stroke Services Expand to Save More Lives

NCH recently opened a new state-of-the-art Neuroin- terventional Suite equipped with the most advanced tech- nology to provide the highest level of care for patients and their families suffering from stroke and other neurovascu- lar disorders. It used to be that when an individual arrived in the Emergency Department experiencing an ischemic stroke, the only treatment option available was the administration of intravenous tPA (tissue plasminogen activator) and only if the individual arrived within three hours of the onset of symptoms. This medication was given to break up the clot so that blood flow would resume in an effort to minimize the effects of the stroke. Although it worked well for some people, it was not appropriate for all types of strokes and the timing was critical. Today at NCH when a patient arrives in the Emer- gency Department, the NCH Stroke Team is immediately activated. The team evaluates the patient to see if tPA is appropriate and simultaneously activates the neurointer- ventional team to evaluate the patient as a possible neuro- intervention candidate. If eligible, the neurointerventional suite is prepared so that the neurointerventionalist Mazen AbuAwad, MD, can remove the clot from the brain to re- store blood flow in the hopes of minimizing the damage from the stroke. “In the past, if a person suffering from a stroke did not arrive in time for tPA, the options were very limited.With neurointervention, lifesaving treatment can occur within the first eight hours expanding the window for care and revolutionizing the treatment for these people,” states Dr. AbuAwad. “Neurointervention is transformational as it

Signs and Symptoms of a Stroke

F.A.S.T. is an easy way to identify a possible stroke: F ace: Ask the person to smile. Does one side of the face droop? A rm: Ask the person to raise both arms. Does one arm drift downward? S peech: Ask the person to repeat a simple sentence, i.e., “Today is a beautiful day.” Can he/she correctly repeat the sentence? Does the speech sound garbled or slurred? T ime: If the answer to any of the above is yes, it is time to act. Call 911 immediately to get the person to the emergency room quickly. Lost time is lost brains cells. ✓ Sudden intense or unexplained headache. ✓ Trouble talking or understanding speech or loss of memory. ✓ Sudden weakness, numbness or paralysis of the arm, leg, face or side of the body. ✓ Sudden difficulty seeing in one or both eyes or double vision. ✓ Sudden fall, dizziness, loss of balance or coordination.

Dr. Mazen AbuAwad, MD

can eliminate devastating side effects for certain patients.” Under the leadership of board-certified neurologists, The Stroke Center at NCH has a team of medical and sur- gical professionals, available around the clock, who special- ize in the rapid diagnosis and treatment of stroke. Stroke is a medical emergency. Everyone should be aware of the signs and symptoms of stroke.

For more information call Merna Martian, NCH Stroke Coordinator, at (239) 624-2116.

NCH takes a ground-breaking step in its partnership with the Mayo Clinic

As a Mayo Clinic Care Network Member, NCH is now able to participate in cooperative research studies solidifying and exemplifying the benefits of the strong collaboration between the two healthcare organizations. One such study, a first for the NCH Cardiac Department, is currently underway with Adam Frank, MD, NCH Interventional Cardiologist, as facilitator. The genesis of the study occurred during one of the initial trips to the Mayo Clinic in Rochester, MN, in October 2012 when Dr. Frank and Naveen Pereira, MD discussed a hotly debated issue in cardiac literature regarding the benefits and efficacy concerns of the drug Plavix. Dr. Pereira wanted to answer the question as to whether or not routine testing was necessary in order to identify patients that may or may not derive maximum benefit from Plavix due to a genetic polymorphism. Plavix or some of the newer “Plavix-like” medications are typically prescribed after a person undergoes angio- plasty. Currently, no official recommendation has been offered by any of the major cardiovascular societies.

Dr. Pereira, who is the lead investigator for the international clinical trial asked Dr. Frank if NCH was interested in exploring the issues and participating in the study “Tailor-PCI” that was in its early stages. NCH decided to participate, and so, the study began. “Basically, the trial involves the use of approved anti-platelet medications for patients who receive coronary stents. We are trying to identify which medications are optimal for use, post-stenting, based on a patients’ ability to metabolize some of these medications,” explained Dr. Frank. With a few exclusions, the trial is open to patients with obstructive coronary disease who require an angioplasty or stent. Research Coordinator Suzanne Kirkland RN, RCIS evaluates and inputs infor- mation into a database of patients. “We perform a cheek swab and from that, we can tell whether or not the patient will metabolize the drug correctly and which drug is best for them,” said Kirkland. “The trial is randomized so half of the patients will get therapy determined by their testing results while the other half will just follow normal physician directives.” There is no risk to those who participate in the trial, patients receive the usual high standard of care regardless of which group they are placed, and only FDA ap- proved medications are used. The study will include 6,000 participants in some 20 centers internationally. “This trial will hopefully provide specific guidance to determine which patients should be tested and if testing proves to be effective, which drugs will provide op- timal benefits with the ability to tailor those medications to their specific genetic makeup,” Frank added. “So, it is one more step to individualizing medicine. The trial will put us on the international cardiology map and is a wonderful advancement for NCH Healthcare System.”

For more information call the NCH Heart Institute at (239) 624-4200.

“Cardiac team Jeff Mays, RCIS, Adam Frank, MD, Kristi Villarraga, RCIS and Joni Spearman, RN prepare to perform an angioplasty on a patient.”

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