Paul D. Johnson and Jennifer J. Majersik: How Utah is advancing care for stroke patients

Advancements will benefit all Utahns, particularly those in rural areas.

(Francisco Kjolseth | The Salt Lake Tribune) Critical Care Nurse Crystal Hale connects with doctors and patients remotely from the Telecritical Care Center in Midvale. Intermountain Healthcare announced the launch of "one of the nation's largest virtual hospital services." It will involve 500 caregivers, offering telehealth services on everything from basic care to stroke evaluation and newborn critical care. The Virtual Hospital Services Testing Laboratory showcased several medical services on Wednesday, Feb. 28, 2018,.

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Oct. 29 is World Stroke Day, a day to raise awareness of stroke, its symptoms and treatment.

During a stroke, part of the brain dies, usually due to an abrupt cut-off of blood flow (ischemic stroke) or less commonly from a ruptured blood vessel. Worldwide, 1 in 4 persons will suffer a stroke. In the United States, stroke is the fifth leading cause of death. Utahns are rightfully proud of their many healthy habits and yet, even in Utah, several thousand suffer a stroke each year. In 2021, 853 Utahns died from a stroke.

Intermountain Health and the University of Utah Comprehensive Stroke Centers are proud to offer the most advanced stroke care available, and are implementing changes that will significantly improve the medications available for stroke treatment.

For many years, a strong blood clot dissolving medication known as Alteplase, first approved by the FDA in 1996, was the only medication available to halt ischemic strokes. Based on multiple recent, large international studies, our hospital systems are jointly moving to replace Alteplase with a newer medication called Tenecteplase.

Tenecteplase can be administered more quickly and easily to stroke patients, with the potential for improved outcomes. Although Tenecteplase has been available for cardiac uses for some time, clear evidence shows its benefit in treating strokes and has provided a crystallized consensus around its use.

Utahns in rural communities may especially benefit from the switch to Tenecteplase due to faster administration, which provides faster transport to designated stroke centers such as the University of Utah or Intermountain Stroke Centers. These centers provide additional advanced stroke therapies, specialized nursing units, and stroke-specific rehabilitation.

Building networks to facilitate rapid stroke diagnosis, treatment and patient transportation via video telehealth platforms, known as telestroke, has been a major achievement of both our healthcare systems. The development and refinement of telestroke systems has dramatically improved stroke care across Utah, helping to reduce disparities of care seen by rural patients.

Adopting more effective medicines such as Tenecteplase is just one of many innovations in stroke care in the past decade. Stroke neurologists now have a multitude of treatments and diagnostic tools to offer. Notable advances include the ability to extract blood clots from arteries in the brain through a minimally invasive procedure called a thrombectomy. This treatment can be combined with blood clot dissolving medications.

Thrombectomies can be dramatically effective for patients who qualify. While our two centers have offered thrombectomy for more than 20 years, only recently has it become clear that thrombectomies are beneficial to patients with larger and later-onset stroke types.

Other recent changes to stroke care include the ability to use advanced brain imaging to select patients who can benefit from stroke therapies beyond the standard treatment “time window.” This includes quickly imaging the blood vessels in the head and neck — or evaluating blood flow within the brain itself.

Both Intermountain Health and the University of Utah now employ artificial intelligence programs to help neurologists evaluate these imaging studies and provide feedback on potential therapies. Employing these technological advances allows physicians to provide treatments to a much larger population of patients than was possible even a few years ago.

Such rapid changes in the science of stroke treatment are the direct result of active research around the world. Utahns are able to access this cutting-edge research through UT StrokeNet, a collaborative clinical trials network funded by the National Institutes of Health, and locally led by the University of Utah with participant hospitals including Intermountain Health, Intermountain Primary Children’s Hospital and the Veterans Affairs Salt Lake City Healthcare System.

UT StrokeNet has enrolled 366 patients in the past five years into prevention, treatment and recovery studies, with 25% of patients living in rural or micropolitan areas.

We’re proud of our institutions’ commitment to offering all eligible patients the most innovative treatments, regardless of where they live. These advances, including the 2023 transition across our healthcare systems to use Tenecteplase, have greatly improved the ability to treat patients who are having strokes in Utah and to reduce death and disability.

However, the greatest benefits of the advanced care we have described lies in our ability to quickly restore blood flow to the brain, whether by blood clot dissolving medications or thrombectomy, to prevent irreversible brain injury. The faster we’re able to intervene on a stroke, the better our patients do long-term.

Common stroke symptoms include the sudden onset of weakness or numbness of one half of the body, the sudden onset of garbled speech, or sudden loss of vision on one side. Sudden, severe onset of imbalance and inability to walk may also be a symptom of stroke.

For any of these symptoms, we strongly encourage readers to call 911 immediately, so they can get immediate medical care. Luckily, through the work of Utah stroke leaders, emergency medical systems are required to bring patients who might be having a stroke to the hospital best suited for their type of stroke.

To learn more about strokes, including prevention methods and treatments, go to www.stroke.org/en/about-stroke or www.cdc.gov/stroke/prevention.htm.

Paul Johnson

Paul D. Johnson, MD, is the Comprehensive Stroke Center director at Intermountain Medical Center.

Jenny Majersik

Jennifer J. Majersik, MD, is the Comprehensive Stroke Center director at University of Utah Health.

Both doctors write on their own behalf. Any opinions expressed do not necessarily represent those of their employers.

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