MultiCare Health System

Welcome to May's E-Health Connect Chat.

May is national stroke month so our topic today is stroke.

Dr. Brian Kott is the South Sound's first endovascular interventional neuroradiologist and the Medical Director of MultiCare Health System's stroke program.

Welcome Dr. Kott.

Thanks.

You're an endovascular interventional neuroradiologist - what does that mean?

Basically, I'm a glorified plumber of the brain. We go through the blood vessels of the brain to treat strokes and aneurisms without invasive surgery.

What are some of your tools?

From inside the blood vessel, we go up with catheters that are designed to run all the way up into the brain, and through these catheters we can use our devices. For instance, to pull out a clot, we may use a Merci Retriever, which looks like miniature corkscrew. To guide our work, we use Fluoroscopy, which is a 3-D, real-time imaging system built into the room itself. Even the treatment table is part of that system.

What exactly is a stroke?

A stroke occurs when not enough oxygen-rich blood is reaching part of the brain. The usual result of a stroke is paralysis of one side of the body. A stroke is an emergency situation and, like a heart attack, requires immediate medical attention.

If I come in with symptoms of stroke, how long does it take to determine whether it's a hemorrhage or a clot?

That should take less than 15 minutes. In a system that is organized and well-tuned to treat stroke, you should be in the Emergency Room and receive a CT scan and have an answer back within 15 minutes. A person has to get through CT scan to be able to answer that very question, because the treatment of those two is completely different. Once it's identified, things move very quickly to get a patient into our operating room where we were able to perform the procedure.

How is the operating room different for people who come in with stroke?

Tacoma General Hospital has two dedicated neurovascular suites - they’re called biplane rooms. They’re operating rooms built specifically to treat or aneurisms or any kind of blood vessel problem in the brain or spine. We're able to use 3-D imaging to guide us while we work. We have a whole team – three nurses on call, two technologists, anesthesiologists and physicians who do the procedure. That all kicks into gear when a patient comes in.

With a stroke, why is quick treatment important?

Time is so critical. Literally each passing minute, more damage is being done to the brain. About 1.9 million brain cells die each minute during a stroke. How much brain you can save depends on how fast you can get to that patient.

To be able to get someone into treatment where the catheter is in their brain in 35 minutes, there are going to be very few focus centers who can do all of that, but one of them is Tacoma General.

If you think someone may be having a stroke, use a simple acronym - F.A.S.T.:

FACE Ask the person to smile. Does one side of the face droop?

ARMS Ask the person to raise both arms. Does one arm drift downward?

SPEECH Ask the person to repeat a simple sentence. Are the words slurred? Can he/she repeat the sentence correctly?

TIME If the person shows any of these symptoms, time is important. Call 9-1-1.

What are some of those symptoms?

Stroke symptoms include:
Sudden numbness or weakness of 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..

Call 9-1-1 immediately if you have any of these symptoms. Note the time you experienced your first symptom. This information is important to your health care provider and can affect treatment decisions.

What's one of the common misconceptions about stroke?

Stroke is often thought of as an elderly disease, and that's absolutely not true. Stroke affects all age brackets.

Why is there a gap in education about stroke?

Up until the last 5 to 7 years, there wasn’t a lot we could do about stroke. It was what it was, and as a result, there wasn't a lot of education. We've done a fantastic job of educating about the symptoms of heart disease. When people have chest pain, they call 9-1-1. But when people get stroke symptoms, almost unanimously, they say, "I went and took a nap." So clearly there's a gap or a lack of education we haven't provided in this country. Sometimes the symptoms are vague. They're not always the typical symptoms where one side of the body is weak.

What's the recovery like after a stroke?

We see particular people who want to get better, and we see them get better and continue to improve. After you have a stroke, you have an injury to the brain. Just like an injury anywhere else in the body, there's swelling. And when there's swelling, things don't work. If someone hits you in the arm, your arm's not going to work well. Same in the brain. The brain is very sensitive to swelling, and it takes a long time for the swelling to go away. The problem is, a lot of elderly people have stroke, and age is not on their side, and whether it's a lack of motivation or other medical complications, that's certainly a factor.

What is the prognosis for someone who has a stroke?

Everyone is different, each case is unique. For any stroke victim who is able to come to recovery, the prognosis is very good. You keep going, you keep doing what you're doing, and you keep having the dreams.

What is on horizon for stroke treatment?

It is probably one of the fastest developing fields in terms of technology. Seven or eight years ago, we didn't have catheters that could get to certain parts of the brain, and couldn't put device in there. It's a very fast moving field, with technology leading the way in that regard. Some procedures are new within the past 8 to 10 months.

What are some examples?

Rapidly developing new devices are coming into the market to pull out these clots, dissolve these clots, repair blood vessels. And we're developing these comprehensive centers like Tacoma General where we're focused and offer all of these options. It's not a small task to put together a team like that.

In addition to the innovative technology, but what about the people?

The coordination, education and execution of this type of system is very exciting. Tacoma General is pretty unique - very few institutions in the whole country have two of these labs. We have physicians who provide 24-7, 365 coverage for the whole area. There are times when we've been running both rooms with people who have had stroke, and we're able to accommodate that. It's an exciting process, seeing the team that we've been able to put together.

Thanks Dr. Kott for joining us.

For more information about our stroke program visit http://www.multicare.org/home/stroke.