Spokane-based Rockwood Health System has begun a new interventional stroke program at Deaconess Hospital.
Located on the 11th floor of the hospital, at 800 W. Fifth, program employees treat patients who have or have experienced strokes, vascular malformations, tumors, or aneurysms.
Dr. Jon Ween, medical director for the stroke program, says the new interventional services allow for a more integrated approach between inpatient and outpatient care, resulting in more efficient and effective operations.
“The interventional side requires certain protocols and a team with the right training and expertise, and while only a select few need that intervention, it is still a vital component,” he says.
A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot, which is an ischemic or acute stroke, or bursts, a hemorrhagic stroke. When that happens, that part of the brain that isn’t getting the blood and oxygen it needs begins to die.
Some patients with stroke symptoms can be experiencing what’s called a transient ischemic attack, also known as a TIA or a mini-stroke, which is caused by a smaller blockage. While a TIA doesn’t leave permanent damage, it does warn of the potential for an impending, more serious stroke, so it’s important that TIAs also are treated quickly to prevent future strokes.
Ween says stroke services begin with emergency evaluations for both acute stroke and TIA in the emergency room, either at Valley Hospital or Deaconess.
“Patients are evaluated for stroke type and cause, and appropriateness of thrombolytic therapy,” he says.
Thrombolytic refers to the use of clot-busting medications called tissue plasminogen activators that break down clots and return normal blood flow to the brain, limiting stroke-related disability. These drugs can be administered intravenously or through what are called endovascular treatments, such as mechanical clot retrieval.
Mechanical clot retrieval involves puncturing an artery in the groin and threading a thin wire tube up into the brain until it reaches the blocked vessel in one of the large arteries. Doctors use the guidance of X-ray imaging technology to advance the tube to the site of the clot.
Once the wire reaches the area, a tube with a wire mesh called a stent retriever at its end is pushed into the clot. The mesh then is expanded so it grabs the clot, which is removed as the tube is pulled out.
When the affected blood vessel is smaller, doctors usually use medication to dissolve the blockage, while larger vessels sometimes require endovascular treatments.
“Across the population, about 10 percent of stroke patients will require endovascular services for mechanical clot retrieval,” says Ween.
He says that in Rockwood’s first three weeks of offering the endovascular services, no patient meeting the need for such a procedure has come in.
He estimates that a typical moderate volume stroke center that offers integrated emergency medical services should expect to see a patient needing endovascular treatment once every two weeks or so.
Although there are other hospitals in town that offer interventional services, Ween says Deaconess is the only one of Rockwood’s three facilities to provide them.
Ween says the purpose of the new interventional program is to provide high-quality care to patients with acute stroke and hemorrhages, but also to expand offerings for elective procedures to treat rarer conditions such as patients with vascular malformations and tumors.
“It serves to fill out our neuroscience offerings that are multidisciplinary,” he says. “Interventional services fit into the wider program for emergency services, but also has an elective component of its own.”
Ween says Deaconess stroke services can involve up to 50 staff members from other areas who also are trained in stroke care, including doctors, nurses, and stroke specialists. The stroke services program also includes three neuro hospitalists and an interventional neurologist.
The Spokane Regional Health District lists stroke as the sixth leading cause of death in Spokane County, with adults over the age of 65 being more likely to have had a stroke than younger adults.
Craig Bakker, neuroscience service line director for Rockwood, says Deaconess’ interventional offerings are the result of new guidelines put in place this year by the American Heart Association for the care of stroke victims.
He says the new guidelines came about as the result of research studies on stroke treatments, showing how interventional treatments can be crucial to patient survival.
Over the last two years, five studies have provided evidence that mechanical clot retrieval can help people who are having strokes, he says. “The American Heart Association has created new guidelines that recommend mechanical clot retrieval based on these studies.”
The American Heart Association has determined that interventional procedures of mechanical clot removal with a stent retriever only should be performed at specialized centers that have providers trained in those types of procedures.
Ween says Deaconess has been certified by The Joint Commission as a primary stroke center since fall 2012.
“This means we have a high quality, integrated stroke team that includes ER, radiology, and hospital staff with an ICU and a stroke unit that can provide thrombolytic therapy and post-stroke supportive care in an expert and expeditious manner, according to published guidelines,” he says.
Both clot-retrieval procedures work better the sooner they can be performed, he says
According to Ween, following treatment at Deaconess, a stroke patient stays in the hospital for a few days, with the duration depending on the type of stroke and the amount of recovery needed.
“High risk TIAs are managed on an inpatient basis based on guidelines and standard assessment tools. Lower risk TIAs are referred to the stroke clinic for comprehensive assessments and appropriate testing,” he says.
Ween says Deaconess evaluates risk of stroke recurrence, and patients are scheduled for follow-up at the hospital’s endovascular stroke/TIA clinic for assessments and to ensure adherence to risk factor modification regimens.
“All patients, whether inpatient or clinic, endovascular or not, are assessed for rehabilitation needs and referred to available resources in the community,” he says.
Deaconess’s endovascular clinic is part of the hospital’s stroke clinic, located within the Deaconess Health and Education Center at 910 W. Fifth. While the clinic has been open for five years now, it recently has added an emphasis on endovascular issues last year with the hiring of Dr. Shyian Jen.
Jen is a neurointerventionalist, vascular neurologist, and endovascular surgeon.
“Prior to my arrival, there was already a lot of planning that went into creating this interventional program,” says Jen. “Once I started, part of my job was to assist in organizing protocols, gathering needed equipment, and allowing for staff and team training so that plan could come to fruition.”
Jen emphasizes the new program’s multidisciplinary approach.
“That initial planning was important, because we work closely with many different teams on a patient’s journey from emergency room arrival, all the way through to discharge and rehabilitation,” she says. “The program here at Deaconess is also unique in that we are neuro-focused, and have the added insight of staff and specialists working in the neuroscience institute.”
The neuroscience institute, which launched last summer, is designed to provide for care with specialists from a variety of fields to diagnose and treat a range of neurological disorders, including stroke.
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