SURVIVING “BRAIN ATTACKS”

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By Michael Schwartz
Photos By Valley Baptist

Valley residents who suffer strokes — “brain attacks” in which oxygen-carrying blood is cut off to their brain by blockages in blood vessels – now have a better chance of survival, thanks to interventional neurology procedures which have been performed for the first time in the Valley at Valley Baptist Medical Center in Harlingen.
The new procedures provide Valley patients with a longer time window in which to survive strokes and hopefully minimize disabilities.   Previously, stroke-reversing medications could only be given if the patient arrived at the hospital within three to four hours after stroke symptoms began.  But the new interventional stroke procedures can be performed up to eight hours or more into a stroke.
Dr. Ameer Hassan, the Valley’s first specially-trained Interventional Neurologist, said in some cases the new procedures can be used up to 12 to 24 hours after symptoms begin — to treat those who wake up paralyzed or with other stroke symptoms which set in overnight.
“This enables us double the time window for treatment – and to treat many more stroke victims,” Dr. Hassan said. “Basically, we are giving people a chance – people who otherwise would have poor outcomes after a stroke.”
“Our goal is to improve treatment for our patients – so that we don’t have disabled or dead patients,” Dr. Hassan added.
In one of the first cases performed at Valley Baptist, Dr. Hassan was able to save 70 percent of the patient’s brain tissue that was at risk of dying.  During the stroke, blood and oxygen were cut off to that part of the brain, by a blockage or clot in the artery in the neck which supplies the brain.  Dr. Hassan used special equipment in a new angiography suite at Valley Baptist to guide a catheter (thin tube) through a blood vessel in the patient’s groin (leg) area and up to the artery in the neck.  He then inserted a thin wire through the catheter, to pull the clot out and clear up the blockage — which allowed blood and oxygen to once again reach the patient’s brain.

In other cases, after Dr. Hassan guides the catheter toward the patient’s brain, he may insert tiny medical devices to clear the blockage.  These “mechanical” devices may include a “Solitaire retrievable stent” – which compresses and “traps” a clot, and is then removed from the body by withdrawing the device through the catheter.  Or Dr. Hassan may use a “penumbra suction device,” which suctions the clot out of the artery –  all the way from the neck or head, through the catheter in the patient’s leg area – acting like a type of miniature vacuum cleaner.

In still other cases, Dr. Hassan may administer a clot-busting medication called tPA through the catheter, to re-open the blood flow to the patient’s brain.   Because the stroke-reversing medication or device is used directly at the site of the blockage, Dr. Hassan said that improvement in blood flow is seen up to 80 percent of the time a patient is treated.  Also, less medication is needed, because it is pinpointed at the exact location where the blockage is located (as opposed to giving the medication through an IV, in which case the medication would be carried throughout the entire body).

In some cases, the interventional treatment can mean the difference between life and death – or the difference in being able to walk and talk again — instead of being completely or partially paralyzed following a stroke.
“This is a huge advancement for Valley patients,” Dr. Hassan said.  “This is top-level care that is usually available only in major cities such as Houston and San Antonio.”
In addition to being the only physician in the Valley trained to perform life-saving interventional stroke procedures, Dr. Hassan will be able to give Valley patients even more options for stroke treatment once the area’s first neurovascular angiography suite opens this Friday (August 10) at Valley Baptist-Harlingen.
In fact, Valley Baptist-Harlingen will be the first hospital in the entire nation to install the “biplane” GE INNOVA IGS 630 neurovascular angiography suite.
“The new angiography suite has state-of-the-art, three-dimensional imaging,” Dr. Hassan said. “We will be able to see inside the blood vessels in a level of detail not possible in the Valley until now. In fact, we will be able the first in the entire country to be able to do ‘3D road mapping’ in order to better diagnose and treat our patients.”
Since the new angiography suite allows physicians to see blood vessels from two “planes”, they will have more options to treat blockages – and not need to use as much radiation during the procedure.
Dr. Hassan, who serves as Clinical Director of Endovascular Surgical Neuroradiology and Neurocritical Care and Clinical Neuroscience Research at Valley Baptist, said his goals include bringing top-level research in stroke treatment and prevention to the Valley.  Dr. Hassan completed Fellowships in Stroke and Neurocritical Care and in Endovascular Surgical Neuroradiology at the University of Minnesota / Fairview Hospital and Hennepin County Medical Center in Minneapolis – and has authored or co-authored 35 articles in national medical journals.
“There is a great need in this area for more education about stroke and advanced treatment,” Dr. Hassan added.  “Many of the major risk factors for stroke – including high blood pressure, diabetes, and high cholesterol – are very common in the Valley.”
Controlling these risk factors is key to reducing the number of deaths and disabilities from stroke in the Valley. Dr. Hassan’s associate, Dr. Victoria A. Parada, said it is also critical for Valley residents to learn the warning signs of stroke — and to call 911 immediately if they or their loved one experiences symptoms.
“Seventy percent of the stroke victims don’t reach the hospital within the first three hours after stroke symptoms begin because they lack awareness of the importance of prompt recognition and treatment of symptoms of stroke,” Dr. Parada said. “Every minute spent without treatment means more brain cells die.”
“Efforts to speed up patients’ arrival at the hospital are absolutely crucial,” added Dr. Parada, who is a Board-Certified Vascular Neurologist and serves as Clinical Director of Neurosciences and the Stroke Program at Valley Baptist-Harlingen. “We have very effective treatments, such as intravenous TPA for patients arriving within the first 3 hours from the onset of stroke symptoms — and interventional procedures for patients presenting up to 8 hours from the onset of symptoms, and for severe strokes. It is critical to always keep in mind that the sooner the patient arrives, the more effective these treatments will be.”
Dr. Parada stressed that Valley Baptist has “a committed stroke team willing to make every effort to help our patients to restore functioning and prevent disability.” The Valley Baptist Stroke Team’s continuum of care for stroke patients includes patient access through Emergency Medical Services; Emergency Department treatment; response by an Integrated Stroke Code Team; diagnosis with the assistance of the hospital’s Radiology Dept. / CT Scan staff, treatment through Valley Baptist’s  angiography suite / cardiac catheterization laboratories, Stroke Unit and Neuro Intensive Care Unit; inpatient and outpatient rehabilitation services to help in the patient’s recovery; and the H.O.P.E. Stroke Support Group, which provides free educational and emotional support to stroke patients and family members.
Dr. Parada said it’s important for Valley residents to know the following warning signs of stroke and teach them to others – because with stroke, every second counts:

•    Sudden numbness or weakness of the face, arm or leg – especially on one side of the body

•    Sudden confusion, trouble speaking or understanding

•    Sudden trouble seeing in one or both eyes

•    Sudden trouble walking, dizziness, loss of balance or coordination

•    Sudden severe headache with no known cause

For more information about prevention and treatment for stroke, consult your physician and visit www.ValleyBaptist.net.