MDNews - Mid Hudson

Stroke Stroke is perhaps the neurologic disease most familiar to the general public, as it is the third-leading cause of death in the United States. Public education about stroke symptoms and the importance of swift treatment has improved substantially during the last two decades, an evolution that has mirrored the improvement of physicians’ understanding of how best to diagnose and treat the disease. Thomas Clark, D.O., Medical Director for Stroke at Sierra Vista Regional Medical Center in San Luis Obispo, CA, has witnessed both improvements firsthand. “Things have changed dramatically since I trained in the early 1990s,” Dr. Clark says. “The rise of public education and the placement of systems of care in both city and community hospitals helped people realize they needed to seek treatment for stroke within three hours of the onset of symptoms in order to take advantage of new medications, such as tissue plasminogen activator (tPA). The effort to see people immediately when they arrived in the emergency department and perform appropriate tests helped limit morbidity and mortality, even if they didn’t receive tPA. Diagnostic tests, including MRI and magnetic resonance angiography, have become much more sophisticated and viable.” Dr. Clark cites several cutting-edge treatment advances that have multiplied physicians’ options when it comes to dealing with stroke. The delivery of tPA through intravenous and intra-arterial means has improved the way in which patients suffering from ischemic stroke receive the clot-busting medication. Physicians 14 | Mid Hudson MD NEWS  MDNEWS.COM are also now able to place stents in cerebral arteries to restore blood flow or perform clot retraction, in which a clot is removed from the cerebral arteries via a catheter inserted in the groin. Just as important as technological advances, however, is the shift in attitude about what it takes to successfully treat stroke, an evolution that has resulted in the stroke care protocols put in place by many hospitals across the country. Such standards of care require a team of multiple specialists working in close collaboration, as well as a specially trained nursing staff. “Stroke care protocols — such as ensuring stroke patients receive a computed tomography scan within a certain amount of time after arriving in the emergency department — are quality measures that help reduce morbidity and mortality on their own, and they’re as significant advances as any high-tech procedure,” Dr. Clark says. “When I was a resident, it was easy to feel hopeless about certain stroke problems, such as occlusion or thrombosis of the basilar artery. Now, I see people who have their arteries stented or undergo clot retraction of the basilar artery and survive, which is phenomenal. Induced hypothermia for stroke patients is another therapy that is showing a lot of promise. “Stroke protocols have changed dramatically during my career, and I think in another 10 years, they will include many more spectacular advances,” Dr. Clark says. “In the meantime, any hospital can improve its delivery of stroke care by taking some simple steps, such as not allowing patients to eat until a speech therapist verifies their ability to swallow, taking steps to reduce patients’ risk of developing pneumonia and instituting measures to prevent deep vein thrombosis.” n

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