Issue link: http://viewer.e-digitaledition.com/i/938319
administering tPA is considered t he best f irst line of treatment for people ex per ienci n g a n i schem ic s t roke, it ca nnot be g iven to patients who have a propensit y for bleeding or to patients who wa ke up w ith stroke sy mptoms, since the time of onset of stroke ca nnot be determined." To b e t t e r a s s i s t t h i s s u b s e t o f patients — as well as a ll those who have strokes — a nd improve outcomes, the tea m at the Stroke & Bra in A neur ysm Center at Good Sa ma rita n ta kes a pro- active, minima lly invasive approach to inter vention. Using coordinated ca re a nd proven best practices, t hey help reduce the a mount of time it ta kes to inter vene, thereby improving sur viva l rates a nd duration of life-impacting side effects. NEUROINTERVENTIONAL TREATMENT A neurointer ventiona l treatment ca lled mechanica l thrombectomy can provide better outcomes for people with la rge vessel occlusions, regardless of whether they have received tPA . The procedure is successf u l at opening la rge vessel occlusions over 85 percent of the time, resulting in the decrease or reversa l of stroke symptoms for ma ny patients. " If you re-va scu la rize t he bra in in time, the patient may sha ke your ha nd with the sa me side that wasn't moving before the procedure," Dr. Bekelis says. " We'll keep the patient at the hospita l for a work up to u nderst a nd why t he stroke occur red, but t he patient ca n go home relatively shor tly therea f ter." Me ch a n ic a l t h r omb e c t omy i s a n endovascula r procedure that involves inser ting a catheter into the g roin a nd threading it through the aor ta to the bra in. Once the catheter reaches the site of t he occlusion, a stent is used t o suc t ion t he clot out of t he ves sel a nd restore blood f low to the a ffected a rea of the bra in. The procedure ca n t a ke 20 t o 4 5 m i nut es t o c o m p l e t e . S i m i l a r e n d o v a s c u l a r p r o c e - dures can a lso be used to treat bra in a neur ysms, t umors, a r ter iovenous m a l f o r m a t i o n s a n d other conditions. " T r a d i t i o n a l l y, t h e t r e a t m e n t o f b r a i n a n e u r y s m s i n v o l v e d performing a craniotomy a nd placing a pin at the site of the a neur ysm to clip it," Dr. Bekelis says. With faster image acquisition, biplane technology represents an improvement over single-plane angiography systems and enables the performance of complex neurointerventional procedures. Under the leadership of Kimon Bekelis, MD, the Stroke & Brain Aneurysm Center's neurosurgeons, neurointensivists, neurologists, nurse practitioners, physician assistants and nurses with extensive training in neurological critical care provide comprehensive and continuous bedside care to patients during their recovery. " We recruited staff from all over the country that included physicians fellowship-trained in neurology, neurosurgery, endovascular surgery and stroke care. We had the team in place in July 2017, and we spent time setting up further training, policies and procedures for the staff before the Stroke & Brain Aneurysm Center opened in September." KEVIN MULLINS, MD, FACS, FAANS, CHAIR OF THE NEUROSCIENCE SERVICE LINE, CATHOLIC HEALTH SERVICES AND CHIEF OF NEUROSURGERY AT GOOD SAMARITAN HOSPITAL MEDICAL CENTER 0 7 M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 018