Stopping the Clock on Stroke Damage

OHSU Extra, Spring 2013

For stroke patients, time is brain. With a limited window to deliver the most effective treatments, immediate access to expert care is imperative. OHSU is delivering stroke care around the clock to communities throughout the state – with doctors who can be in two places at once.

In early November 2012, a stroke paralyzed Emil Evans from the tip of his right toe to the tip of his right finger. Three days later, he was back raking leaves in the yard of his McMinnville, Ore., home. Many are not so lucky. Stroke is the fourth leading cause of death in the United States, and nearly a third of those who suffer strokes are left with a lasting disability. Evans attributes his own remarkable rebound to the expertise of OHSU stroke specialists – brought to his bedside by the OHSU Telemedicine Network.

“I think it was a prime mover in my recovery,” the 83-year-old retired high-tech executive said.

Evans’ story began on November 4, when he was struck by a dizzy spell, prompting family members to call 911. Paramedics took Evans to Willamette Valley Medical Center in McMinnville, where emergency room physician Siobhan Gray, M.D., immediately suspected he had suffered a stroke. Gray called OHSU to request a telemedicine consultation and wheeled a sophisticated communications cart, equipped with high-resolution cameras, to the emergency department exam room. From a computer station 38 miles away, OHSU neurologist Hormozd Bozorgchami, M.D., was able to control the cameras, see, hear and examine Evans. He asked Evans questions, had him do simple tasks to assess his cognitive ability, and asked Evans’ family about his medical history. “It was almost as if Dr. Bozorgchami was there in the room,” said Evans’ wife, Darrell. “I felt as if we were having a conversation.”

The immediate treatment telemedicine enables is critical for stroke patients because the more quickly a patient is assessed, the better chance doctors have of saving the oxygen-starved portion of the brain. Bozorgchami recommended that Evans receive the clot-busting drug t-PA, a proven stroke treatment that must be administered promptly. However, t-PA only dissolves about one third of large clots such as Evans’, and in his case more treatment was needed. Evans was ultimately taken to OHSU where the clot was removed using one of the latest stroke treatment devices, a stent retriever, available only at major research hospitals and large medical centers. Physicians at OHSU were leaders of the multi-center clinical trial that resulted in the approval of this device.

Two days after the surgery, physicians sent Evans home. “They insisted I take a walker,” Evans said. “I have no more use for a walker than a hog has for roller skates.”


Serving the region – remotely

Such success stories are being repeated across the region. OHSU stroke neurologists have helped treat more than 250 patients at community hospitals in Oregon since telestroke services began in April 2010.  “I can perform the same stroke exam by way of telemedicine as I do in person,” said Helmi Lutsep, M.D., professor of neurology at the OHSU School of Medicine and associate director of OHSU’s Oregon Stroke Center. As a result, Oregonians are receiving the right treatment at the right time at rates far higher than the national average. Thirty percent of OHSU’s telemedicine patients are receiving t-PA, versus two to three percent of patients nationwide, providing a greater opportunity for stroke recovery.

The potential for telestroke care goes beyond the emergency room. With philanthropic support, telestroke services could be expanded to include stroke recovery care and prevention for at-risk patients in rural areas. By equipping new collaborating hospitals with telemedicine technology, training and support, more patients will be able to access the OHSU expertise that made such a difference for Emil Evans.


Before and after – expanding care along the continuum

The groundwork for expanding stroke care is already being laid by Lutsep, who along with Darren Larsen, R.N., a nurse coordinator in the stroke center, recently founded the STEP (Stroke Therapy, Education, and Prevention) program with support from donors Julie and Rocky Dixon.

“Julie and I enjoy backing innovative, hard-working people and projects,” said Rocky Dixon. “Like many physicians at OHSU, Helmi Lutsep fits the profile of a dedicated researcher and caring physician. We feel privileged to be able to support her in this endeavor.”

The STEP program is designed to improve follow-up care for patients leaving the hospital after a stroke; the goal is to expand the program to include telemedicine outreach to discharged patients across the state. It would also provide the means to monitor high-risk rural patients who have not yet had an acute stroke but exhibit warning signs such as a “mini” stroke or certain genetic markers.

“The gift from Rocky and Julie Dixon has helped us accomplish more than I even imagined,” said Lutsep. “Because of the STEP program, we have shown improved blood pressure control in our patients. The program has led us to explore ways to bring follow-up visits to those who live far from OHSU by using telemedicine.”  The goal is to serve more patients, in more communities, at all points along the spectrum of stroke care. “Philanthropic support is helping us drive innovation in the delivery of stroke care,” said Lutsep.