A new angiography suite at Georgia Health Sciences Medical Center allows doctors to more precisely evaluate and remove clots in stroke patients.
It enables what Neurosurgery Chairman Dr. Cargill Alleyne describes as "seeing past the clot. The suite’s imaging system delivers clear, three-dimensional pictures of the arteries and veins in the brain and neck so we can better pinpoint blockages. You can't do that with standard stroke imaging," he said.
The Primary Stroke Center at Georgia Health Sciences Medical Center is the first in the state and one of the first three centers in the nation to acquire VasoCT.
"We inject contrast through the veins, and it circulates through the heart and backflows to the other side of the blood clot, enabling us to see exactly what we are dealing with before we go in," said Dr. Scott Rahimi, a Georgia Health Sciences University Vascular Neurosurgeon. "Previously, when someone came in with a stroke, we'd inject dye into the patient's artery to find the clot, and the dye would stop at the clot. We really couldn't see much else, until we went in."
Now neurosurgeons at GHSU can see the location, size and direction of each clot. "It gives us a road map of where to go so we can more precisely plan and deliver treatment," said Alleyne.
This means that diagnostics and intervention can happen together in the angiography suite, saving critical time – and brain cells – for each patient. Using a catheter to access the affected vessel, the clot can be removed mechanically or by direct administration of the clot-busting drug tPA. Following clot removal, a second dye study is done throughout the body to confirm that blood flow has been restored.
An intravenous dose of tPA is the first line of defense against a stroke, but it doesn't always work. Time also is a factor because tPA administered more than three to four hours after stroke symptoms may trigger a brain bleed. The angiography suite extends that treatment window to about eight hours.
"After three to five minutes without oxygen, brain cells are in real danger," Rahimi said. "The window for removing a clot and restoring blood flow is eight hours but, in reality, the clock starts ticking as soon as the brain is without oxygen. The sooner oxygen flow is restored, the better."
Besides providing the only interventional stroke care in the region, the angiography suite enables neurosurgeons at Georgia Health Sciences Medical Center to more quickly diagnose and treat hardening of the carotid artery as well as blood vessel defects such as arterial venous malformations and aneurysms.
"We can complete a variety of diagnostic and therapeutic procedures faster, and that means the patient is off the table and on the way to recovery and discharge much sooner," Alleyne said.
Stroke is the third-leading cause of death in the United States and the number one reason for adult disability, according to the Centers for Disease Control.
GHS Medical Center, located in the heart of the Stroke Belt, is designated as a Primary Care Stroke Center by the Georgia Department of Public Health Office of EMS and Trauma and the Joint Commission on the Accreditation of Health Care Organizations. The medical center recently received the Gold Plus Quality Achievement Award from the American Heart Association/American Stroke Association for achieving 85 percent or higher adherence to all of the national Get With The Guidelines Stroke Quality Achievement Indicators for two consecutive years.
Patients in rural Georgia hospitals have fast access to quality stroke care at GHS Medical Center through REACH Health, Inc., a telemedicine program pioneered at GHSU that allows neurologists to diagnose and treat stroke patients without actually being there. Hospitals in partnership with GHS Medical Center delivering remote stroke care include Burke Medical Center, Coliseum Medical Centers, Elbert Memorial Hospital, Emanuel Medical Center, Fairview Park Hospital, Jefferson Hospital, Jenkins County Hospital, McDuffie Regional Medical Center, Morgan Memorial Hospital, Palmyra Medical Center, St. Mary's Hospital, Tift Regional Medical Center, Ty Cobb Memorial Hospital, Washington County Regional Medical Center, West Georgia Hospital and Wills Memorial Hospital.