AcuteCare Telemedicine Blog


Stroke Treatment Gets a Boost

Fifty years ago, the only advice medical textbooks gave physicians for someone suffering with a stroke was to put him to bed and keep him comfortable, hoping that with time, the brain would heal as best it could. For 30 years, promising techniques preceded disappointing trials. First, heparin was going to be the savior, and for most of the 70s and 80s, it almost served as a standard, but better studies eventually showed that the treatment was not just worthless, but in reality dangerous, causing more brain hemorrhages than no treatment at all. Later, drugs that were intended to clear out “free radicals” were going to save the ischemic penumbra, part of viable brain tissue around a central core of dead cells, but all studies showed that either the medication didn’t get to the target, didn’t work, or could even be toxic to the brain.

In the mid 90s, tissue plasminogen activator (TPA), long used for heart attack victims to break up the clots inside arteries of the heart, was shown to be effective in doing the same in arteries of the brain. For the first time, physicians had something to offer patients that actually made a difference. About a third of patients who received TPA had better three month outcomes than those that did not. This success rate was quite good, but patients with severe strokes still did not respond as well because, in most cases, thrombi in the large arteries were not effectively dissolved.

Only in the last few years have studies been done to consider the effectiveness of a thrombectomy, the process of physically pulling out a thrombus inside an artery in the brain or neck, The early devices available to physicians are fairly good at the task, but a substantial number of patients continue to suffer from residual blockages of the arteries following the procedure.

A report of clinical trials using two new types of thrombectomy devices, called Solitaire and Trevo Retriever, show both of these new devices as being up to five times more effective than their predecessors in opening up arteries. Advances this drastic are rare in medicine, but physicians should be optimistic about the potential for these instruments in improving outcomes. Provided that patients can have access to skilled practitioners in time, within eight hours or sooner, the treatment of stroke may be about to enter a dramatic new phase.

Stroke is the most serious disabling condition in adults, resulting in hundreds of thousands of permanent injuries and deaths every year. This decade may witness the greatest advances in the history of stroke treatment. There are still further trials to run, but with these exciting new prospects, the importance of stroke neurologists like the doctors of ACT being present in every emergency room, either in person or by remote presence, cannot be overstated.



Information in an Instant

There are countless factors that prevent patients from getting to see their doctors. Sometimes the simple fear of ‘getting sick’ and missing time at work or important commitments to our friends and family can stop us. Other times, distance, obligation, or extreme weather conditions can inhibit our ability to get to the hospital, even in cases of emergency. Whether the problem is voluntarily or logistically difficult, doctors and patients have long looked for solutions to these challenges to create a better standard of care.

Thankfully, the 21st century has afforded society some incredible opportunities to mitigate the barriers that stand between people and adequate healthcare services. Many disciplines of medicine are now mobile, capable of patient and doctor interaction regardless of the distance separating them. We have medical devices and software that can perform tasks such as automatically reading and uploading vital statistics for patient monitoring directly into an electronic health record. It has already been widely shown that reducing unnecessary hospital visits results in cost savings for the provider and the patient alike. Now, technologies such as those used in this type of monitoring is also enabling doctors to take better care of patients, helping them maintain an open line of communication, without being too invasive.

Between new monitoring techniques and the proliferation of location-based services, doctors can now effectively keep 24/7 tabs on at-risk patients, and might even be capable of sending the appropriate emergency response to victims of heart attack or stroke. It is mind-boggling to think that through powerful new devices and lightning-fast internet infrastructure, a doctor could actually know a stroke is progressing before the patient does.

With the prominent role we as a society assign to technology, it seems only fitting that it is now working to help save our lives. Physicians 50 years ago could hardly have envisioned these futuristic capabilities; it is an extremely exciting time to be practicing medicine on the cutting edge of technology.



What Stroke and Heart Attack Have In Common

Because brains and hearts are highly dependent on oxygen-rich blood to survive, current guidelines from the American Heart Association call for treatment in under an hour for both strokes and heart attacks. The phrase “Door-to-treatment” refers to the time it takes from a patient’s emergency room arrival to the initiation of treatment.

In heart attacks, “door-to-balloon” more specifically refers to the use of an angioplasty balloon to relieve a constricted or obstructed blood vessel. In cases of stroke, the key phrase is, “door-to-needle,” referring to the administration of the intravenous medication tPA. The two different organs, with different vascular beds and dealt with by different teams of specialists within a hospital, remain subject to very similar constraints in time and quality measures.

The care of these patients requires a team approach with emergency room nurses and doctors rapidly initiating the process. At all hours, parallel specialized teams must stand ready to reverse critical brain and heart ischemia. Telemedicine technologies have proven to be an efficient solution in allowing very rapid access to quality care.

As leaders in the fight against the morbidity and mortality of these emergencies, AcuteCare Telemedicine (ACT) leads the stroke team at several hospitals, ensuring that proper treatment is available to patients within the critical hour. In addition, ACT monitors stroke care and provides important feedback to the hospitals it serves, because constant evaluation of the timeliness and quality of treatment is a crucial component in reducing the “door to needle” time to help save lives.