Issue 4 Stories
Sentara in the Community

Neurointervention: A New Treatment for Stroke

Sentara Blue Ridge Region Hospitals Work Together to Save Stroke Patients

For Kelly Via, 48, of Luray, Christmas of 2016 was fairly normal: traveling out of town to visit with family and returning home—nothing out of the ordinary. But the day after Christmas is one she will remember for a long time to come. That’s the day she woke up with the symptoms of a stroke she had experienced while she slept.

“I knew something was different,” Via says.

The day began with her alarm going off. Via didn’t hear it, but her boyfriend, Steve, did. He was already up, and he began to wonder if something was wrong when Via still hadn’t stirred after 20 minutes.

“He came into the room, and I managed to stand up but I couldn’t walk to him,” recalls Via. “As he helped me back into bed, he asked me to raise my arm, but I couldn’t. My arm wouldn’t move, and my face was drooping on the right side. My speech was also slurred.”

Steve, who had experienced a stroke himself previously, immediately recognized the signs and called 911.

The Luray emergency medical services (EMS) team came quickly, assessed Via and took her to the Sentara RMH Emergency Department (ED) in Harrisonburg, about 40 minutes away. While in route, the team notified the ED staff to expect the arrival of a stroke patient. ED physician Christina Johnson, MD; on-call neurologist Nando Visvalingam, MD; and the rest of the Sentara RMH stroke team were waiting for Via when she arrived.

“With any stroke, time is extremely important,” explains Dr. Johnson. “When a stroke occurs, it means the patient is no longer getting blood to a section of the brain—either due to a clot that is blocking a blood vessel in the brain or due to an aneurysm, or rupture, of a vessel that causes blood to hemorrhage into the brain tissue. The longer the affected section of the brain is deprived of blood flow and oxygen, the more brain cells will die. The immediate result manifests in the type of symptoms Kelly was experiencing. The long-term result, however, can be permanent disability or death—particularly if treatment is delayed.”

Upon her arrival at Sentara RMH, Via was taken quickly to Imaging Services for a computed tomography (CT) scan of her brain. The scan showed that she had suffered an ischemic stroke, caused by a clot in a major blood vessel in the left side of her brain.

The normal means of treating an ischemic stroke is to give the patient the clot-busting drug Alteplase (also known as tissue plasminogen activator, or tPA), as long as it is administered within three hours of the onset of stroke symptoms. In Via’s case, unfortunately, the actual time of the stroke occurrence was unknown.

“When a person awakes with stroke symptoms the way Kelly did, we typically don’t give Alteplase, because we don’t know when the stroke symptoms actually began,” says Dr. Visvalingam.

A New Technique for Treating Some Stroke Patients

Fortunately, in Via’s case, another newer treatment option, thrombectomy, was available through the neurointerventional radiologists at Sentara Martha Jefferson, the sister hospital to Sentara RMH in the Sentara Blue Ridge Region.

“A thrombectomy is a procedure in which we insert a small catheter, or tube, through the groin or wrist and guide the tube to the patient’s head,” explains John Gaughen, MD, a neurointerventional radiologist with Sentara Martha Jefferson. “Through the catheter, we use instruments to remove the clot and restore blood flow to the brain.”

Dr. Gaughen works closely with both Sentara Martha Jefferson and Sentara RMH to treat stroke patients in need of this type of treatment.

In many cases like Via’s, when a stroke patient at Sentara RMH requires neurointervention, an air ambulance transports the patient to Sentara Martha Jefferson. On that late December day, however, fog had grounded the air ambulance, so Via was taken to Charlottesville by traditional medical transport.

“When I got to Sentara Martha Jefferson, they took me into a fairly dark room,” says Via. “I could see Dr. Gaughen, though, and there was something like a TV screen above me.”

That screen allows neurointerventional radiologists to observe in detail the procedure taking place inside the patient’s arteries. Dr. Gaughen performed the thrombectomy immediately, and the procedure took less than an hour.

“I didn’t feel much during the procedure,” recalls Via. “Then I was brought to my hospital room in intensive care. When I saw my family waiting, I couldn’t understand why they looked so sad, or even why they were there. I wasn’t talking all that well, but I could talk, and I could move. I felt OK!”

Via says that her three days in the hospital went well. She enjoyed interacting with the “nice and friendly staff” at Sentara Martha Jefferson, and especially with Dr. Gaughen, who helped her so much when she first arrived.

Today she is back to her regular routine and doing well, and she has stopped smoking to help improve her cardiovascular health and reduce the risk of suffering another stroke. “My last cigarette was on Christmas day,” she notes. “It’s hard because I work in a bar, but I’m doing it.”

Airlifted for Stroke Treatment

Nov. 28, 2016, began like most mornings for Bridgewater resident Terry Slaubaugh.

“I came out of my room to eat breakfast,” remembers Slaubaugh, 78, a retired mathematician. “Everything seemed as it usually is, but after I had some coffee and set my cup down, I couldn’t pick it up again.”

Fortunately, his wife, Vickie, was with him and knew the symptoms of stroke. She noted the time—10:10 a.m.—and called 911 immediately. She then stood by his side and helped hold him upright in his chair.

“I had read about the signs of stroke,” she says. “Terry’s face was drooping on the left side, and he had weakness on that side. His eyes didn’t look right, either. I told him: ‘You’re having a stroke.’”

The emergency responders arrived, quickly assessed Slaubaugh, and started an intravenous line. They then called ahead to alert the Sentara RMH ED that they had a stroke patient in transit, and by 10:30 a.m. he was at the hospital. A CT scan revealed a clot on the right side of his brain.

Based on the size and location of the clot, Slaubaugh was a candidate for thrombectomy. The Sentara RMH ED staff immediately arranged for his transport by air ambulance to Sentara Martha Jefferson.

“That was a horrible feeling to see him being taken off, not knowing what his condition would be,” recalls Vickie, who quickly made her way to Sentara Martha Jefferson.

When Slaubaugh arrived, neurosurgeon Jeffrey Mai, MD, and his team were already waiting to perform the thrombectomy. Additional CT scans of the patient’s brain were taken, and Dr. Mai began by entering an artery in Slaubaugh’s groin area. Slaubaugh was given mild sedation to calm him, but he remained awake throughout the procedure.

“I felt some pressure, but I didn’t feel any pain,” Slaubaugh says. “I remember that Dr. Mai thought it interesting that I was asking him about the mechanics of the procedure. Being a mathematician, I’m interested in that sort of detail.”

Slaubaugh’s stroke and thrombectomy occurred on a Monday, and he was released from the hospital that Friday, after a few days of observation. He describes his hospital stay as excellent.

“The friendly staff and the environment in my room made me very comfortable,” he says.

Upon discharge from the hospital, Slaubaugh went to a skilled nursing facility for rehabilitation. He returned home right before Christmas.

Today, Slaubaugh—who has used a walker since before his stroke due to a hereditary condition, and continues to use it today—is doing well. He feels a bit tired at times, but he exercises regularly to build his strength and is dedicated to working toward full recovery.

“Dr. Mai told me it might take 8-12 months to get back to the way I was,” he says. “I’m very grateful for the help of Dr. Mai and the staff at both Sentara RMH and Sentara Martha Jefferson—and also for the local EMS and helicopter crews who responded so quickly.”

A Medical Miracle

Before Slaubaugh left Sentara Martha Jefferson, Dr. Mai encouraged him to share his story with the Sentara RMH community and help spread the word about this new neurointerventional procedure.

“He told me that a large part of my success was due to the steps taken by EMS and the team at Sentara RMH to get me to the place where he could remove the blood clot and save my life,” notes Slaubaugh.

When talking about their experiences, both Via and Slaubaugh use the same word: miracle.

“No doubt, Dr. Gaughen performed a miracle on me,” says Via. “That’s the only thing I can call it, considering the difference the procedure made for me.”

Adds Slaubaugh: “This sort of thing—the research that has gone into perfecting this treatment, the doctors who take the time to learn and perfect the necessary skills, and the first responders and other providers who work together as a team—it’s all a miracle.”

Helipad Enhances Stroke Care in the Sentara Blue Ridge Region

Sentara Martha Jefferson Hospital and Sentara RMH Medical Center have partnered to offer air ambulance service for stroke patients who need neurointerventional care in the Sentara Blue Ridge Region. A new helipad at Sentara Martha Jefferson was opened in July 2016 to support the air ambulance service, which is provided by AirCare 5 Medevac, operating out of Shenandoah Valley Regional Airport in Weyers Cave. Under normal conditions, air transport from Sentara RMH to Sentara Martha Jefferson takes about 14 minutes.

The AirCare 5 helicopter is outfitted with advanced medical equipment and staffed by highly trained personnel, who care for patients in flight before transfer to caregivers at Sentara Martha Jefferson. The air ambulance service is available to patients coming from Sentara RMH, as well as from other locations throughout Central Virginia.

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