Brain Attack Hub and Spoke System Offers Lifesaving Endovascular Therapy
Medical City Las Colinas, AMR and Medical City Las Colinas work together as a “Drip and Ship” and “Mothership” model to save patient from a life-altering disability.
During a recent trip from India to North Texas to visit her daughter, a 79 y/o woman began experiencing a sudden onset of right sided weakness and speech difficulty around 5:15 pm. She arrived via car at 5:59 pm to the ED at Medical City Las Colinas, a certified primary stroke center.
The Las Colinas ED team activated code stroke four minutes from the patient’s arrival. The patient had a history of A-fib, hypertension and presented with right sided weakness and expressive aphasia which correlated with a NIHSS of 12. The CTA revealed a left MCA, or large vessel occlusion (LVO) and IV- tPA was administered at 6:55 pm. Because the CTA revealed a LVO and there was no improvement in the patient’s symptoms post IV-tPA, Medical City Las Colinas consulted with the Texas Stroke Institute at Medical City Plano, a certified comprehensive stroke center. Arrangements for transport to Medical City Plano via AMR were coordinated through the Medical City Healthcare Patient Transfer Center.
The patient arrived at Medical City Las Colinas with significant expressive and receptive aphasia, dysarthria, right-sided facial weakness and mild right-sided weakness of the arms and legs. A CTA and MRI confirmed a left MCA stroke with a left M1 occlusion.
The patient was taken directly to the IR lab and a thrombectomy of the left MCA was performed with the Stryker Trevo® XP Provue, in conjunction with thromboaspiration using a Penumbra® aspiration catheter. The patient had 100% reperfusion of the brain tissue, otherwise referred to as mTICI-3.
The patient discharged with a NIHSS of 2, reflecting mild expressive aphasia and no weakness or facial droop. The recognition of a LVO and the rapid triage and transfer of this patient to a certified comprehensive stroke center resulted in an exceptional outcome.
We must strive to recognize LVOs and treat fast. The recent landmark trial ESCAPE showed a 10% absolute decrease in good outcomes and a 5% absolute increase in mortality each hour that care is delayed. We must work as a system of care for the expeditious diagnosis, transfer and treatment of patients with brain attacks.
To learn more about the Texas Stroke Institute, go to texasstrokeinstitute.com.