Telestroke Program: Faster Stroke Response

Stroke is the fifth leading cause of death and a leading cause of disability in the United States. Recent strides in neurological services at Providence Saint John’s Health Center mean more patients than ever with stroke and aneurysm are regaining all or some function related to speech, cognitive functioning and mobility and more patients are getting this new stroke treatment more quickly.

At the forefront of these advancements in neurological treatment is the first-of-its kind telestroke program. This program serves as a command center of sorts, staffed by neurologists who specialize in stroke diagnosis via video conferencing. The hospital is a Primary Stroke Center— a designation that means the facility is staffed with expert stroke neurologists, stroke-trained nurses and therapists who can deliver the highest standard of care.

When health care providers at the hospital call a “code stroke,” a telestroke neurologist is summoned for an immediate video evaluation of the patient. Through a two-way, high-definition teleconferencing system the neurologists consult with staff—usually in the emergency room— in evaluating patients suspected of stroke. Why the rush? The stroke treatment mantra is “time is brain”. That means that the quicker a patient can be evaluated and appropriate treatment started, the greater the chances at brain preservation. Through the telestroke program, the hospital aims to have patients evaluated by a physician within 15 minutes of arrival to the emergency room.

“We’re very excited about this program,” says Jason Tarpley, MD, PhD, director of the Pacific Stroke and Aneurysm Center at Pacific Neuroscience Institute located at Providence Saint John’s. “ Everyone is aware that traffic on the westside of Los Angeles plays a crucial role in getting patients to the hospital on time. The telestroke program allows patients to receive game-changing treatment much sooner, reducing the potentially debilitating effects caused by stroke.”

By far the most common type of stroke is ischemic, which occurs when a blood vessel supplying blood to the brain is blocked. Ischemic stroke accounts for some 87 percent of all stroke cases, according to the American Stroke Association. Tissue plasminogen activator, or tPA, is the most effective medication for ischemic stroke victims. The medication works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood. But there’s a catch, tPA is most effective when administered as soon as possible from the time of symptom onset, up to 4.5 hours. “Now, when patients get to us they are more stable and we can assess whether further treatments may be required. This generally involves a minimally invasive procedure where the stroke-causing blood clot in the brain is snared with a wire cage-like device called a stentriever. This slender device is threaded into the artery and is used to pull the clot out and restore blood flow.”  Dr. Tarpley adds, “Knowledge of the patient’s condition prior to their arrival at the hospital allows us to be prepared to treat them appropriately as soon as they are admitted.”

Adapted from “Saving Brains” by VICTORIA CLAYTON in Providence Health Magazine Fall 2016 issue.