For far-flung and local patients alike, stroke care often starts en route to Harborview — with emergency services like Medic One and Airlift Northwest. Harborview’s ER is also on the alert for potential stroke patients. “The system automatically has a quick checklist, looking for red flags for stroke as it does for cardiac problems,” says Johnson.
Next comes a CT or MRI scan, which can help determine if the patient had a stroke. Then the team weighs the patient’s options, based on the type, size, severity and timing of the stroke. “You want fast, accurate evaluation and immediate access to treatment,” says Bruce R. Ransom, M.D., Ph.D., UW professor and chair of the Department of Neurology, and the Warren and Jermaine Magnuson Endowed Chair in Medicine for Neurosciences. “Access to this high level of care can be life-saving.”
Some patients with hemorrhagic stroke are eligible for neurosurgery; others with ischemic stroke can receive intravenous (IV) tPA. “We can administer IV tPA to somebody within 30 minutes of presentation when all goes well,” says Kyra J. Becker, M.D., UW professor of neurology and neurological surgery and co-director of the Stroke Center.
Other ischemic stroke patients are candidates for angiographic interventions. These image-guided therapies are delivered by experts like Basavaraj (Raj) Ghodke, M.D., Fel. ’03, UW associate professor of radiology and neurological surgery, director of neuro-interventional radiology, and co-director of the UW Brain Aneurysm Center, and Danial K. Hallam, M.D., M.Sc., UW associate professor of radiology and neurological surgery.
Most patients arrive after the 4½- hour window required for intravenous tPA has closed, explains Ghodke. In those cases, interventional neuroradiologists may use sophisticated scanning and catheter-based techniques to deliver tPA directly to a clot. Or they may perform a mechanical thrombectomy, another catheter-based therapy in which doctors remove clots either by inserting a corkscrew-type coil through the neck to snag the obstruction, or by using a tiny vacuum.
“We’re fortunate to have the best diagnostic neuroradiology and therapeutic neurointerventional team in the country,” says Norman J. Beauchamp, M.D., MHS, UW professor and chair of the Department of Radiology. Their expertise, he says, pays dividends — such as the relationship they’ve developed with medical technology companies. Take Penumbra, Inc., for example, the company that developed the vacuum-based system.
“We’re the first center in the Seattle area to use Penumbra,” says Hallam, noting that he and his colleagues have helped the company develop better catheters. UW Medicine also partnered with Philips Healthcare to develop Harborview’s high-tech angiography suite. In other medical centers, patients would need a separate scan to measure perfusion — an indication of blood flow and blockage in the brain — at a time when every minute counts.
With Harborview’s one-stop angiography suite, no time is wasted, says Ghodke. “We can monitor our progress by doing these perfusion angiograms during the procedure itself,” he says.
Kyra Becker gives stroke patient Phil Farr a test to assess his coordination. “We do the same thing with drunk drivers,” says Farr, a police officer with 30 years’ experience.