The Journal Gazette
Sunday, June 30, 2019 1:00 am

Tech speeds stroke detection, treatment


Joe Brita had just finished overseeing construction of the $30 million Allen County Juvenile Center. That's when the symptoms started.

Brita dismissed the occasional blurred vision and balance issues as nerves surrounding the large project, but things got worse. At times, he felt like he was having an out-of-body experience.

He started phoning doctors, with each blaming it on high blood pressure. He changed medication and even doctors, but after three hospital visits, nothing was changing. About three months passed.

“One time in the middle of the night, I woke up and said, 'There's something terribly wrong. I need to go to the hospital,'” Brita said. “From that point, I remember very, very little. Almost nothing.”

When he ended up at Dupont Hospital, doctors learned Brita was having a stroke. To be treated, he would need to be transferred to Lutheran Hospital, the only facility in-network capable of doing interventional therapy for stroke.

However, it was Memorial Day weekend, and Brita would have to wait for a neurointervention surgeon to drive in.

Dr. Amit Sanghvi ended vacation early and headed to Lutheran the same day. After two MRIs, Sanghvi located and removed the clot, saving Brita's life.

“With the stroke that he had, you almost think the person is drunk. It isn't just losing your arm and legs, it's just a decreased level of consciousness,” Sanghvi said. “They start slurring their words, they start not making sense, they start breathing shallow and they get to a point where they actually stop breathing.”

The whole process from when Brita was experiencing onset symptoms at Dupont to having his clot removed lasted about six hours.

But that was in 2010. With today's stroke technology, treatment and transportation, time has narrowed to two hours or less, Sanghvi said.

Since Sanghvi came on board in 2006, Lutheran has become one of four comprehensive stroke centers in Indiana. It's routinely staffed with neurosurgeons, a stroke neurologist, stroke therapists and stroke coordinators. The facility also offers a neuroangiography suite and neuro ICU to have a space dedicated to treating strokes.

To speed the process of detecting a stroke and evaluating a patient's condition, the health care system added a dynamic volume CT scan and RAPID stroke analysis software in 2018.

With RAPID, about 2,000 images of the brain can be taken within minutes. The software chooses the most crucial images, and makes them easy to interpret for physicians.

“The RAPID and the perfusion technology, it's a measure of how quickly the blood is getting to the brain. It can quickly show us if the blood is delayed to a certain part of the brain,” Sanghvi said. “The next step, once you know the blood is delayed to that section of the brain, it helps us calculate whether or not the brain is still salvageable.”

The technology will highlight salvageable parts of the brain in green, but “dead” brain tissue areas will be pink.

Based on the images, doctors decide if they should be aggressive when trying to get the clot out, or if it's at the point where they can do any other helpful intervention.

Speed is important because for stroke patients, 3.6 years of life are lost for every hour untreated.

“If there's penumbra (salvageable) tissue, then we want to be able to get all of our patients to the interventional operating area as quick as we can,” Sanghvi said. “We've taken turnaround times that were anywhere from two to six hours and we're trying to get everyone from 60 to 90 minutes from the emergency room to the catheterization laboratory.”

From there, patients are taken to the lab, where doctors puncture the groin, similar to heart attack procedures. Catheterization wires and tubes are connected to the brain.

Two different types of devices are used to remove the clot; both work to grab the clot and clear it from the brain.

Along with the new analysis software, doctors can also access the RAPID images on their phone.

With RAPID's capabilities, Sanghvi said the center has been able to screen more patients, increasing volume by 50%.

While the technology feels near perfect to Sanghvi right now, he knows in the future, it will only get faster.

He hopes the technology will become more automated soon, allowing Lutheran's regional hospitals to take advantage and treat stroke patients on site.

“We have a network here, and we're sort of the hub, and all of our local hospitals are spokes. Right now, we're offering the technology at the hub hospital,” Sanghvi said. “Our goal is to offer the technology to all of the spokes in the near future. That way you can get evaluated there instead of transferring here to get the RAPID profusion.”

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