In the Nick of Time

Expansion project pushes stroke center to new levels.

The human brain is like a universe all its own, and inside each little universe, there are billions upon billions of neurons, which are special cells that process and carry information to other parts of the body such as the nerves, glands and muscles.

A new piece of equipment has greatly expanded the stroke center’s ability to care for stroke victims.

Christine Gonzalez, RN, CNRN and Ralph Gonzalez, MD

These neurons are the basic component of the human nervous system, and just as it is with stars in a galaxy, when they die out, they don’t come back. They’re gone for good, and their absence can negatively affect the function they were designed for.

That’s why time is of the essence anytime someone suffers a stroke, which is what occurs when the blood supply to an area of the brain is cut off, most often by a blood clot that has either formed in the brain or moved to it.

Researchers have discovered that for every minute a stroke victim is not being treated, nearly two million neurons die right along with 14 billion synapses, which are the mechanisms that trigger the neurons to pass their signals on to the next cell.

Medical science has worked for years to create tools to help stroke victims win the race against time, and the best one yet is now available at the Stroke and Cerebrovascular Center at Manatee Memorial Hospital, which focuses on stroke prevention, intervention, rehabilitation and education.

That tool is an FDA-approved, unique therapy platform that aids physicians in a stroke treatment procedure called endovascular mechanical thrombectomy, during which blood clots are removed from the brain in an effort to ensure better outcomesfor the patient.

“We’ve had all the other pieces in place to be able to do this except the Bi-plane  unit,” says Ralph Gonzalez, MD, a board-certified neurology and vascular neurology specialist and Chief of Staff at Manatee Memorial Hospital.

“We’ve got the neurologist, the neurosurgeon and the radiologist, but it was that one piece of equipment, the Azurion Image-Guided Therapy System, that we didn’t have. Now, we’re the first and only stroke center in Manatee County that has it.”

Vacuum Effect

Also referred to as an angiographic x-ray lab, the new unit allows a physician to remove a blood clot from the brain by first running a catheter through an artery in the groin, up through the neck and into the area of the brain where the blood clot is located.

Using x-ray guidance, a secondary device is fed through the catheter to a point just beyond the location of the clot. The retriever then expands the walls of the artery to reestablish blood flow before it pulls the clot out.

“It’s like a little vacuum cleaner that goes up and sucks the clot out,” Dr. Gonzalez says. “And it increases the likelihood of a stroke victim regaining independence and mobility by a significant amount over those who get only tPA treatments.”

tPA, or tissue plasminogen activator, is a clot-dissolving medication that has long been used as an initial treatment for strokes. The drug is delivered intravenously through the arm, but the time frame during which it can be administered is very limited.

“The IV tPA needs to be administered by three or in some cases four and a half hours following the onset of symptoms,” Dr. Gonzalez explains, “because after that time period expires, there is a high incidence of hemorrhaging.

“That’s frustrating because there are a lot of people out there who have had strokes that went into a primary stroke center, but because it was more than four and a half hours after they were last functioning normally, we couldn’t do anything about their stroke.”

That narrow treatment window was widened a few years ago when a series of studies proved that mechanical thrombectomy could safely be performed at any point up to six hours after a stroke victim was last known to be functioning normally.

The window was further expanded to 24 hours for select patients in 2018, but for the staff at the Stroke and Cerebrovascular Center at Manatee Memorial Hospital, the absence of the equipment required to perform the procedure continued to limit their ability to care for patients.

“We were moving patients to other hospitals, and we weren’t alone,” Dr. Gonzalez says. “A lot of counties have started bypassing primary stroke centers to go to places that can do thrombectomies.

A new piece of equipment has greatly expanded the stroke center’s ability to care for stroke victims.

The staff at the Stroke and Cerebrovascular Center is excited about the addition of the angiographic x-ray lab to its arsenal.

“The problem is that it may be another fifteen minutes to get to a stroke center that can perform a thrombectomy. That’s fifteen minutes of added time, and when you’re losing a few million neurons a minute, that’s fifteen minutes you can’t afford to waste.

“That’s why it’s such a huge benefit to have added this new equipment. Patients in Manatee County will no longer need to bypass us to get the best care possible. The number of patients who can benefit from this technology has grown exponentially.”

So too have the chances of those patients regaining functional independence. Studies show that the combination of an endovascular mechanical thrombectomy and tPA treatment improves the chances of stroke victims regaining independence by as much as 60 percent.

More to Come

The Stroke and Cerebrovascular Center at Manatee Memorial Hospital takes a team-based approach in evaluating and treating stroke emergencies that allows for streamlined treatment and services.

The arrival of the new equipment is part of a multi-million-dollar expansion of the center that includes advanced diagnostics, and Dr. Gonzalez says there is still one more addition to the unit to come.

“We’ve made the step from a primary stroke center to one that performs endovascular mechanical thrombectomy. We will soon be able to offer the full suite of procedures, including the coiling of aneurysms.

“We’re not there yet, but the addition of the new equipment is a big step toward getting there. And from the standpoint of a stroke neurologist, I’m just over the moon that the administration here at Manatee Memorial Hospital trusted us enough to do this.

“They allow us to guide them in terms of what is needed for the citizens of Manatee County so that, in the event of a stroke, patients no longer need to be sent outside of the county to get the best care possible.”

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