changing the course of stroke - New Jersey Medical School ...

BATeam members work staggered shifts to cover their unit
around the clock. Minutes after a page by EMS, other mimicking
conditions are ruled out, and the type of stroke is determined,
“We are ready to go,” explains Michael Lee, angio and
X-ray technologist. In the case of an acute ischemic stroke, “We
use a local anesthetic and the patient, who is conscious, feels no
pain from the procedure.” Fast-flowing jets of saline solution at
the tip of the catheter and the pumping action of the body’s
own bloodstream speed the trip.
Inside the angio room, imaging equipment can move along
ceiling tracks. Cabinets of devices, long guidewires, catheters
and coils for mechanical clot disruption or retrieval and cerebral
drug delivery are along one wall. At center stage beneath more
computer monitors, the patient is draped in plastic. His body
may be nearly invisible on the table but not his brain or the vascular
system of highways which feed it. “Embolization has
changed how we do AVMs,” Prestigiacomo explains. “I always
embolize first. You can turn a 12 to 15 hour operation into a 6
to 8 hour procedure and though it’s still challenging, it’s not the
blood bath that it used to be.” This man will wake up in good
condition, go home in two days and return for further surgery
in a few weeks.
Linda Foggie, angiotech supervisor, explains, “Ours is the
only hospital around with multiple views of the patient— AP
(anterior/posterior) and lateral— at the same time,” as well as
three dimensional. This AP monitor, a futuristic, big white arc,
can swing panoramically around the patient to catch images
from inside his head at every angle. “Old cerebral angiograms
Linda Foggie, Mike Lee, and Andrea
Hidalgo (clockwise from top)
used to take three to four hours and then diagnostic
took two to three hours more,” she recalls.
What has pushed UH past the standard stroke
medical response is this marriage of radiology and
neurology. “The ability to accomplish results so fast
takes technology and teamwork,” Farkas says. “For
years, our team has been led by Andrea Hidalgo, MD, a
stroke neurologist, who is still a front-line person. She
meets the patient, quickly excludes all other conditions,
consults with the family and stretches her responsibilities long
into treatment.”
As for Farkas, personal experience plays a part, too. As a 24year-old
medical student, he recalls, “I watched my grandmother
collapse from a stroke. She died even though the EMS arrived
within minutes.” Back then, there was nothing anyone could do
for her. “It was a quick and probably painless way to die, but I
always felt that she had more to give me. So now, I spend my
time navigating the blood vessels of the brain and spinal cord.
Stroke is the most rewarding thing that I could do.”
DOWN THE RESEARCH ROAD
O n
the back of a 10 page packet of New Jersey Health
Department statistics showing the sad reality of stroke in
the state and a belt of even higher numbers for the Newark area,
Adnan Qureshi, MD, quickly sketches a brain under attack. A
neurologist and researcher trained in both stroke and endovascular
work, Qureshi has just arrived from the University of
Buffalo Medical School to head the fast-growing stroke unit.
BATeam leaders, like Patrick Pullicino, MD, PhD, and
Abutaher M. Yahia, MD, University Hospital’s new director of
neuro-critical care for stroke (who is also from Buffalo), call
Qureshi a stroke pioneer.
With pen in hand, he points to the core of primary cell death
being deprived of oxygen (anoxia) because of a thrombus in a
vessel. Here’s the penumbra, or surrounding tissue, in danger of
dying from a secondary wave of toxic chemicals being released
by the brain’s own cells.
“This cascade of events within the brain is so damaging,” he
explains, “and we are trying to understand these processes
which start immediately in a stroke and can continue for many
hours.” Brain cell injury will result from this disruption in
blood flow at the core. There may be no way to save those first
cells at the center from dying within three to five minutes and
becoming non-functioning, necrotic, fluid-filled cavities
(infarcts). However, just outside that dead zone, this penumbra
N EW JERSEY MEDICAL SCHOOL 15