By Sandra Wurdemann St. Luke's News
Stroke ranked as the fourth leading cause of death for Idahoans in 2007 when St. Luke’s doctors decided to enhance and coordinate care for those patients.
That year Dr. James Torres, an emergency room physician at St. Luke’s, began leading St. Luke’s effort to standardize protocols, organize processes, and educate people about stroke care. He contacted national stroke experts and worked with a team of healthcare professionals to orchestrate reliable stroke care across the system from emergency responders to the emergency departments and hospitals.
By 2011, stroke dropped to the fifth leading cause of death in Idaho. The number of stroke patients receiving perfect stroke care at St. Luke’s Treasure Valley (Meridian and Boise) increased to 83 percent in 2012 from 76 percent in 2011.
St. Luke’s Treasure Valley passed its Primary Stroke Center certification in September 2012, a seal of quality showing that its facilities provide evidence-based, standardized care and are committed to accountability and continual process improvement.
“It’s really a commitment to the best advanced, most contemporary treatment for the people in Idaho,” said Dr. John Perl, a St. Luke’s interventional neuroradiologist.
St. Luke’s Magic Valley is working through the same process with hopes of becoming a primary stroke center by the end of the year.
Torres said St. Luke’s in the Magic Valley and the Treasure Valley now provide the same quality stroke care, and the goal is to reach that level system-wide.
“We really have evolved,” Torres said. “Now we get it right all the time.”
Recent St. Luke’s patients say their care and the results have been excellent. Just ask Dylan Leavitt of Twin Falls.
On Dec. 28, 2012, Leavitt, then 18, and his girlfriend had planned a date night to see “Les Miserables,” the movie. But while shaving, he fell to the bathroom floor.
His right side went limp and he blathered words that didn’t make sense, his girlfriend told him later. She gave him an aspirin as his family called paramedics. Leavitt was having a stroke.
Leavitt was taken to St. Luke’s Magic Valley for tests and received the clot-busting drug tPA, or tissue plasminogen activator, before being transported by air ambulance to St. Luke’s Advanced Primary Stroke Center in Boise.
In Boise, Leavitt’s symptoms would improve and then return, so doctors ordered an angiogram to see what was going on in his brain. Leavitt had a big blood clot on the left side that hadn’t been dissolved by the drug. To compensate, his body was sending blood through collateral arteries that were not strong enough to hold the flow, causing the symptoms to come and go, said Dr. Nicholas Lazzaro, the interventional neuroradiologist who pulled out the clot using a Solitaire stent.
“It was an unusual case because of his age,” Lazzaro said.
St. Luke’s has been using two new similar clot-pulling devices since about April 2012 with great success, the Solitaire stent made by Covidien and the Trevo stent by Concentric Medical. Both have been FDA approved and available for about a year. The stents are self-expanding and retrievable. Physicians push them through the blood clot to open a vessel and then retrieve them to extract the clot, which gets caught in the mesh-like stent.
“I appreciate that they didn’t skip any steps,” Leavitt says.
Leavitt, a student at College of Southern Idaho who plans to major in nursing, left the hospital after three days. He expects to recover fully and says his only symptom now is that his right side is a little uncoordinated. St. Luke’s doctors found that his body tends to create extra blood clots. As a preventative measure, he now takes an aspirin a day.
“It’s really gratifying to be able to make a difference in someone’s life, especially an 18-year-old,” Lazzaro said. “To see patients go from a profound weakness or deficit to start moving their hand or talking within seconds – that’s why we do what we do. It’s always nice to hear how they’re doing and know you made a difference.”
Dr. Tony Bell, an interventional neuroradiologist at St. Luke’s, successfully treated a 28-year-old woman nearly paralyzed with a stroke last year. The woman has no residual effects and is fully recovered. Bell says that’s why he does his job. “The impact I made in her life, you can’t measure that.”
Deborah Hill-Williams, a nurse and consultant who monitored two large stroke clinical trials on the West Coast, says leadership and support across the health system are vital to a successful stroke program.
She said she saw both those attributes when St. Luke’s treated her for a stroke in 2012. That year, Hill-Williams, a resident of the Seattle area, often traveled to Boise to monitor a clinical trial that was not stroke related. About 11 p.m. one night, she saw a flash of light in her eye as she put her head on her pillow. She had difficulty breathing and sitting up. She realized she was partially paralyzed. She was able to call the desk clerk at her Eagle hotel and tell her to call 911.
St. Luke’s staff in Meridian started treatment as soon as she came in the door. A CT scan using contrast was performed to spot a large blood clot in her middle cerebral artery. Hill-Williams said she was given tPA and began to feel her toes and her cheek lifting within five minutes. She was transferred to the Boise hospital for monitoring. A heart condition related to her pacemaker was behind the stroke. She has almost no effects from the stroke now. And St. Luke’s care bought her more time to enjoy the birth of her first grandchild, she said.
“St. Luke’s didn’t miss a single beat with me,” she said. “The post-procedural care was stellar in the ICU. The nursing care was excellent. They can take care of me anytime.”
Stroke experts say getting the right treatment as soon as possible is crucial in stroke care.
“The most important thing patients or their families need to know is time is brain,” Lazzaro said. “They’ve got to get to the hospital. If they have symptoms and they’re not sure, they just need to come to the hospital.”
Lazzaro says rehabilitation with strokes can be challenging, especially if the artery doesn’t get opened right away.
After returning home, Hill-Williams heard about two people, one a surgeon, who didn’t pay attention to their symptoms and were severely disabled by strokes.
“You or the person with you has to recognize what has happened,” she said. “It doesn’t matter if you’re wrong.”
Leavitt said he had symptoms about a week before his stroke.
“My right arm was going numb,” he said. In jest, his sister asked if he was having a stroke.
“If something’s wrong, definitely check up with a doctor and be honest with them,” Leavitt said.
St. Luke’s Treasure Valley also created a cutting-edge Transient Ischemic Attack (TIA) Center, the only center of its kind in Idaho, dedicated to rapid evaluation and treatment to prevent stroke and further damage in patients experiencing TIA. The program was created by St. Luke’s. A TIA is a small stroke where symptoms are usually short in duration, but can often mean an impending stroke may occur in the next few hours to several days. About 87 percent of all strokes are ischemic. In the Treasure Valley, specialists with the TIA Center are onsite at St. Luke’s Boise and Meridian Emergency Departments 24 hours a day, seven days a week.
“TIAs last less than 10 minutes, but should get to the hospital,” Torres said.
Still, the best technology, protocols and professionals are only useful when people recognize a problem and seek help.
“People say let me see if it goes away, wrong. You need to get to the hospital,” Dr. Torres said.
The surveyor from The Joint Commission was impressed with St. Luke’s TIA Center protocols and plans to share them nationwide, Dr. Torres said.
In addition St. Luke’s opened a Neurointervention Clinic in October under the leadership of Dr. Bell and Dr. Perl. The clinic sees out-patients who have conditions related to the brain and spinal column, such as aneurysms, hardened arteries and spinal compression fractures. Treatments use minimally invasive techniques. These treatments often eliminate the need for open surgery and can lead to less pain, shorter hospital stays, improved outcomes and decreased cost.
Bell treated hundreds of patients during a two-year fellowship and was a faculty member at several academic institutions for eight years. Perl completed a two-year fellowship and a one-year interventional neuroradiology fellowship, treating several hundred cerebrovascular patients. He also was on the staff of a nonprofit academic medical center for 10 years. Bell and Perl are well-known nationwide in their specialty and have expertise on par with premier medical centers in the country.
“The clinic is one more arrow in the quiver of St. Luke’s commitment to neuroscience,” Perl said.
Sandra Wurdemann works in the Communications and Marketing department at St. Luke's.