Monday, October 31, 2011

First Catheter-Based Stroke Treatment Case at Lunder

Yoo and Hochberg

LAST MONTH, AN ACUTE STROKE SERVICES team took advantage of the state-of-the-art tools and resources in the new Lunder Building to perform the first case of intra-arterial stroke embolectomy and reperfusion for acute large vessel stroke in the Lunder Building.  Otherwise known as catheter-based stroke treatment, a catheter is placed into an artery and moved up to the clot and is extracted by a specially designed wire or device where tPA, a protein used to help breakdown blood clots, is often administered.  This method can be more effective than traditional intravenous (IV) tPA, because the catheter mechanically disrupts the clot and allows the tPA to reach the clot in a quicker manner when compared to IV treatment.

Leigh R. Hochberg, MD, PhD, an associate neurologist for Acute Stroke and Neurocritical Care Services and Celine Rahman, MD, a NeuroCritical care fellow, say that teamwork was essential to the case. Rahman and Hochberg assessed the patient to determine whether she was eligible for therapy. The patient had initially received intravenous tPA, which proved insufficient in dissolving the clot.

'“The patient displayed clinical signs of a large artery stroke syndrome and her imaging revealed blockage of two major arteries that feed a large portion of the brain,” says Rahman.

"Our combined clinical and radiologic examinations confirmed that there was a substantial region of brain tissue and was ‘at risk’ [of dying] if adequate blood perfusion was not restored quickly," adds Hochberg. "When treating acute stroke, 'time is brain."

The two physicians consulted Ronil V. Chandra, MD, Thabele Leslie-Mazwi, MD, and Albert J. Woo, MD, of Interventional Neuroradiology Services, to further evaluate the the patient.  After careful consideration of all of their findings, the team elected to move forward with this treatment which has been used since 1991 at MGH in various forms –- which proved to be successful and demonstrated positive radiographic results.

Lee H. Schwamm, MD, vice chairman of the Department of Neurology and director of TeleStroke & Acute Stroke Services, says that planning and training that occurred before the move to Lunder was critical to the team's success.

“A mock patient drill the week before uncovered vital aspects of the stroke treatment workflow that had not yet been addressed. Over the past five years of quality improvement work and use of small tests of change, we learned to appreciate the power of the mock drill. Simply put, the new winner in heatlh care is the team that can fail early, retool and learn from its mistakes,” says Schwamm.

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