The most serious stroke cases, ones where clots block blood flow to the brain, can now receive critical, time-sensitive treatment at John Peter Smith Hospital.
Using a stent retriever, Dr. Joseph Schniederjan, an interventional radiologist, and his team can pull the clot out quickly, possibly preventing lifelong debilitating paralysis or even death.
Tarrant County’s public hospital performed the first such emergency procedure Feb. 12 and expects to do many more. The high-tech process requires precision teamwork from multiple disciplines to find the clot and guide the stent to it. Once there, they open the stent up, grab the clot and pull it out.
Previously, JPS relied on drugs such as tissue plasminogen activator, or tPA, to break up clots, but they haven’t been effective on the largest and most dangerous blockages, Schniederjan said. Those blockages forced JPS to transport those patients to either Texas Health Harris Methodist Hospital Fort Worth or Plaza Medical Center of Fort Worth, where the stent procedure was already being performed.
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The time lost while transporting patients was critical, Schniederjan said, because the longer the brain is starved of oxygen, the more brain cells are killed.
“Time is brain,” Schniederjan said. “The faster we get to the hospital, the faster you recognize the signs and symptoms of a stroke, the more likely your outcome is to be better.”
Strokes are the fifth-leading cause of death in the United States.
‘Great and exciting time’
Terrance McCarthy, emergency medicine physician and chief of staff at Texas Health Resources, said they’ve been performing the stent procedure for several years, including on referrals from JPS.
Using the stent retriever is much better for patients than drugs, McCarthy said.
“This is a great and exciting time for stroke care,” he said. “For the last several years, the only acute treatment that we had in our tool belt was the so-called clot buster, tPA.”
Intuitively, it made sense to use a stent to pull out a large clot, but the medical community lacked the research to back that up. A recent study by the New England Journal of Medicine changed all that.
“It was so confident, it showed such a great benefit to the patients, that the other four studies stopped early,” McCarthy said. “It’s not right for every patient. But, if you do find the right patient, this could really make a difference, that’s for sure.”
More than just the procedure itself, McCarthy said credit also goes to the nurses who take care of stroke patients, who are at risk of having high blood pressure and other health problems.
Procedure has ‘dramatic’ effect
Schniederjan was on the cutting edge of this procedure six years ago when he did his fellowship at a hospital in Providence, R.I. There, he worked with Dr. Mahesh Jayaraman, now the director of interventional neuroradiology at Rhode Island Hospital, who has been working for more than a decade to improve stroke care.
Jayaraman performed some of the first clinical trials in 2003 while at Stanford University. Older methods involved using a corkscrew to reach the clot rather than the advanced stent retrievers that are used now.
“All of us in the field knew this was the right way to do it,” Jayaraman said. “We just didn’t have the tools and technology and structure to do it rapidly.”
Now, he and Schniederjan and other doctors are seeing the fruits of their labors.
“The revolution is not just about a single device or doctor, it’s organized teams that provide this care in an extremely rapid fashion,” Jayaraman said.
His research has shown that brain tissue dies much faster than anyone anticipated. He’s seen the stent retrievers work miracles for patients.
“There are very few things in medicine that have as dramatic an effect as this procedure,” Jayaraman said.
‘Means a lot to our patients’
JPS took the initiative to open a new stroke center in October, transforming the types of stroke procedures they can perform.
Lauri Speirs, a clinical nurse specialist in the stroke program, said JPS will apply this year to become a comprehensive stroke center. Currently, there are less than 20 such accredited facilities in Texas, Spiers said.
That’s especially important for the at-risk population that JPS primarily treats, Spiers said.
“It means a lot to our patients. The patient population that we have, they don’t always get to choose where they go,” Speirs said. “To have that at the county level where we take in all patients, that’s fantastic.”
For Schniederjan, a father of three, providing care to the patients at JPS is his passion. He attended the University of Texas at San Antonio for medical school and did his radiology residency at Baylor Houston before doing his fellowship at Providence Rhode Island.
“Patients can be a little more complicated here in a sense that they are so proud of what they are doing and who they are that they don’t come in until the disease progression sometimes is later on down the line,” he said. “They don’t always get the preventative care that someone else with insurance might get. It’s more of a challenge at this hospital, but I think also most of the time the patients are most appreciative of the help.”
Signs of a stroke
B is for balance. A person having a stroke may struggle with balance or seem uncoordinated.
E is for eyes. A sudden change in vision could be a sign of a stroke.
F is for face. One side of the face, or just the mouth, may appear to droop.
A is for arms. If asked to raise both arms, a stroke victim may not be able to keep both in the air.
S is for speech.Words may be difficult to understand or nonsensical.
T is for time. Waste none. Call 911. If you’re in the main hospital, the pavilion, call 1120.
Source: JPS Hospital