Stoke Alert! Newsletter Fall 2020 by Baptist Health

Neurological Institute

Stroke Alert! Alert! Fall 2020

See Debbie Haynam”s story inside

THIS ISSUE FALL 2020

• B aptist Medical Center Jacksonville receives highest honor for Stroke Gold Plus hospitals • Educational Opportunities • A race against time • We don’t just follow the standards, we create them • Telestroke

Baptist Medical Center Jacksonville receives highest honor for Stroke Gold Plus hospitals The American Heart Association and American Stroke Association recognize all adult hospitals in the Baptist Health system for a continuing commitment to comprehensive stroke care. Recognizing high levels of adherence to treatment guidelines and dedication to improving outcomes for stroke patients, the American Heart Association (AHA) and the American Stroke Association (ASA) have designated Baptist Medical Center Jacksonville a Stroke Gold Plus Honor Roll Elite with Advanced Therapy Achievement Award. Baptist Jacksonville was selected to advance for continued excellence in stroke patient care, receiving the highest level of award possible for a Gold Plus hospital. The award acknowledges Baptist Jacksonville’s commitment to providing state-of-the-art stroke treatment according to nationally recognized, research-based guidelines. Baptist Health aims to ensure the highest quality of clinical care for all stroke patients. “Baptist Health is dedicated to providing excellence in stroke care for our community,” said Michael A. Mayo, FACHE, hospital president of Baptist Jacksonville. “We are proud to receive national recognition for our Stroke & Cerebrovascular team’s efforts.”

When it comes to stroke, every second, from the time a patient enters the hospital to the time a patient receives treatment, counts. According to the AHA, a typical patient loses around 2 million neurons each minute after suffering a stroke until treatment. Improved patient outcomes are directly linked to how quickly a patient receives care after experiencing stroke symptoms. “We strive to be at the forefront of new technology, research, clinical trials and treatment advancements in stroke care,” said Ricardo Hanel, MD, PhD, neurosurgeon and co-medical director of the Baptist Stroke & Cerebrovascular Center. “Thanks to these developments, our patients experience better long-term outcomes.” For more information on diagnostics, care and door-to-treatment response times for stroke, visit the Baptist Health’s Stroke & Cerebrovascular Center page.

Honor Roll Elite with Advanced Therapy status is awarded to hospitals that display high levels of success following benchmarks outlined by the AHA’s Get With The Guidelines® – Stroke and Target: Stroke program. To earn this award, hospitals must: • A chieve door to thrombolytic therapy treatment time under 60 minutes for 85% or more of patients undergoing acute stroke interventions. • A chieve door to reperfusion device times within 90 minutes for at least 50% of patients for direct arrivals and within 60 minutes for transfers.

Exceptional. It’s what we do.

Pictured, left to right: Nima Amin Aghaebrahim, MD Medical Director, Primary Stroke Centers Ricardo Hanel, MD, PhD Director, Baptist Neurological Institute Endowed Chair of Stroke and Cerebrovascular Surgery Eric Sauvageau, MD Director, Stroke and Cerebrovascular Surgery Endowed Chair of Stroke and Cerebrovascular Surgery

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2019

EDUCATIONAL OPPORTUNITIES SAVE THE NEW DATE M

The Sixth Annual Innovations in Cerebrovascular Science Conference March 3 - 6, 2021

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Sixth Ann ual Innova Cerebrova tions in scular Scie nce Confe rence Ponte Ve

dra Inn & Club Vedra Blvd., Ponte Vedra Beach, FL 32082 experts in adult and pediatric ne Topics will uroscience inc lude innov Complex . ations in: Aneurysm Treatmen Ischemic t • Neuroc and Hemo rit ica l Care • rrhagic St roke • Ne uroradiolog y Please visit the conferen ce website events.biz to register zabo.com/ now Innovation sCerebroSc ience 200 Ponte

Learn from internation al

Neurologica l Institute In collabora tion with the Stys Neurosc at Wolfson Children’s ience Insti Hospital tute

Strokes, Aneurysms and Carotids: Risk Factors, Identification and Treatment Webinar Series

Aneurysms, Strokes, & Carotids: Who Is At Risk and When To Screen (August 12, 2020): https://youtu.be/Yj4myiTr_AY

Aneurysms, Strokes, & Carotids: Accurate Evaluation, Emergent Diagnosis & Treatment When an Emergency Presents (August 13, 2020): https://youtu.be/bGhGlH-vN5Y Aneurysms, Strokes, & Carotids: Current Review of Innovative Techniques & Cutting Edge Approaches (August 14, 2020): https://youtu.be/JxF6ycH7joA CME credit has been extended until December 31, 2021.

A race against time

Call 911 immediately if you notice stroke symptoms. It was a Thursday morning and Debbie Haynam was excited for her son, Brian, to arrive. She was busy getting everything ready at her home on Amelia Island, as moms are known to do, even when their children are all grown up. The next thing she knew, she was lying on the kitchen floor. Haynam remembers seeing her sandal dangling off her foot and not being able to get it back on, no matter how hard she tried. “I wiggled across the tile until I made it to a chair, and somehow hoisted myself up to it,” she said. When her son arrived, he found his mother sitting in the chair looking confused. His hello was greeted by silence; Haynam wasn’t able to speak. “I knew my son was there,” she said, “but I couldn’t respond to him.” Fortunately, he knew exactly what to do, and called 911 immediately.

Swift action Nassau County Fire and Rescue Department arrived in minutes to take her to Baptist Medical Center Nassau’s Emergency Department. Her son and husband, Doug, followed. When Haynam arrived at Baptist Nassau’s ER, the medical team was ready and prepared to care for her. “Debbie couldn’t speak and didn’t comprehend our questions,” said Baptist Nassau emergency physician Annette Bell, MD, who rushed Haynam immediately to the CT scanner to get images of her brain. Dr. Bell was able to connect with Nima Aghaebrahim, MD, an interventional neurologist at Baptist Stroke & Cerebrovascular Center in Jacksonville, through TeleStroke a virtual way to assess patients with stroke symptoms. He was able to see Haynam in real time and also immediately view her CT scans. “There was an obvious blockage on the left side of her brain, cutting off the oxygen supply,” said Dr. Aghaebrahim. “I could see that she had weakness on her right side and difficulty speaking. The clot needed to be removed as quickly as possible.”

Within minutes after Dr. Aghaebrahim confirmed her condition, Haynam was on the LifeFlight helicopter headed to downtown Jacksonville. When she arrived, the entire stroke team at Baptist Stroke & Cerebrovascular Center was waiting, ready to spring into action. She was whisked into the operating room where Dr. Aghaebrahim began an emergency thrombectomy to save her life. A thrombectomy is a procedure to remove a blood clot in an artery and restore blood flow along with oxygen back to the brain. “As we did with Debbie, thrombectomies are usually performed by going through the femoral artery in the groin and guiding a catheter up to the clot in the affected area in the brain,” said Dr. Aghaebrahim. He was then able to apply suction to aspirate the clot.

Successful surgery “When I woke up in the recovery room, I had no idea what had happened,” Haynam said. “They were asking me questions — what day it was, how old I am — and I was able to answer them easily. My husband told me I had suffered a major stroke. I couldn’t believe it.” Stroke is the No. 1 cause of disability, and time is crucial when it comes to stroke. A person loses an estimated 1.9 million brain cells in the first minute of a stroke. Every minute a stroke goes untreated can mean an extra week of recovery. Yet, many people are still delaying emergency care in light of COVID-19. Emergency department visits are down 42% across the U.S. due to COVID-19, according to the CDC. “For Debbie, delaying care could have resulted in longterm or permanent disability on the right side of her body and problems with speech and language,” said Dr. Aghaebrahim. “That’s why calling 911 immediately is necessary if you notice stroke symptoms.”

Stroke symptoms Baptist Stroke and Cerebrovascular Center’s treatment times are faster than national averages to help ensure the best possible outcomes for our patients. “In Debbie’s case, it was less than 90 minutes from the time she arrived at Baptist Nassau’s ER until I began her procedure,” Dr. Aghaebrahim said. This included transporting her by LifeFlight from Baptist Nassau to downtown Jacksonville. “Quick care played an important role in Debbie’s recovery because restoring blood flow rapidly is the key to a good outcome when it comes to a stroke with a large vessel blockage,” Dr. Aghaebrahim said. “This can only happen with great teamwork between Emergency Medical Services, our ER team members and our neurovascular team,” he said. ”It’s important to know that not all hospitals are equal when it comes to stroke treatment. At Baptist Health, we have protocols in place for rapid and effective care for patients like Debbie, along with excellent surgical and post-operative care.”

A stroke can happen to anyone Haynam’s friends and family were surprised she suffered a stroke; she is a healthy and active retiree who enjoys playing tennis, running and Jazzercise.

“Unfortunately, a stroke can happen to anyone at any age. Debbie had atrial fibrillation, and at the time of her stroke, she was not taking blood thinners. So, despite her being otherwise healthy, she was at high risk for stroke,” Dr. Aghaebrahim. Dr. Bell said Haynam’s situation is an example of excellent coordination between Nassau County Fire Rescue, Baptist Nassau (an Acute Stroke Ready Hospital) and Baptist Stroke and Cerebrovascular Center. “I feel really proud of the care that we as a team provided to her. I am grateful for the trust she and her family placed in us, and I am so happy that she is well again,” Dr. Bell said.

“ In this time of COVID-19, we have taken great care to ensure that the ERs and other departments in our hospital are safe and equipped to provide safe and excellent care.” Annette Bell, MD Baptist Nassau emergency physician

Road to recovery Haynam is relieved she has no disabilities resulting from her stroke, and is getting back to her normal activities — like walking her dogs, doing yard work and swimming. She hopes to return to the tennis court soon. “Make sure that people around you know the signs of a stroke and know to call 911 right away,” Haynam said. “My son knew what to do and he really saved my life.” Stroke symptoms include face drooping, arm weakness, difficulty with speech, sudden loss of balance or coordination, and sudden vision loss or double vision. Baptist Health ERs have a separate area for patients who are experiencing stroke symptoms. Call 911 or go to the ER immediately — time is brain when it comes to stroke treatment.

We don’t just follow the standards, we create them We are pleased to highlight the following trials for this quarter. Timeless This study aims to evaluate the use of the thrombolytic tecnecteplase in extended window time (4.5-24 hours) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Currently, intravenous alteplase is the standard of care, but its use is limited to the first 4.5 hours of the event (AIS). Only patients with a vessel occlusion (ICA or MCA) and penumbral tissue will be randomized. The primary analysis is to compare the efficacy of tenecteplase versus placebo in all patients at Day 90. n n

T enecteplase in stroke patients b/w 4.5 and 24 hrs P urpose – evaluate the efficacy and safety of tenecteplase compared with placebo in pts w/ AIS

n Inclusion

• A ge ≥ 18 • A IS symptom onset within 4.5 to 24 hrs & symptoms consistent w/ anterior circulation stroke (ICA, M1 or M2) • NIHSS ≥5

Prost This study aims to evaluate the safety and effectiveness of the pRESET thrombectomy device (stent-retriever) compared to Solitaire™ Platinum revascularization device in the treatment of stroke-related to large vessel occlusion. Currently, there are other stent-retriever devices approved for the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (i.e., Trevo, Embotrap, Tigertriever). pRESET presents as an alternative revascularization device. n pRESET

for occlusive stroke treatment

n Purpose

– Evaluate the pRESET thrombectomy device compared to Solitaire in large vessel occlusion

Inclusion • Age ≥ 18 • Treatment within 8 hrs of symptom onset and w/in 1.5 hr from imaging to groin puncture • NIHSS ≥ 6

Advance Purpose – to assess the safety and effectiveness of Pipeline Vantage Embolization device with shield technology for wide-necked intra-cranial aneurysms n Inclusion • Aneurysm in the ICA, neck ≥ 4mm or a dome-to-neck ratio of < 2 • Aneurysm has a parent vessel w/ diameter 1.5-5 mm • Age 22-80 yrs n

For a complete list of all current Baptist Health Research Institute trials please visit https://www.baptistjax.com/patient-info/baptist-research-institute/clinical-trials

Crest-2 Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial n Purpose

– The purpose of this trial is to determine the best way to prevent strokes in people who have a high amount of blockage of their carotid artery but no stroke symptoms related to that blockage. CREST-2 is two independent multicenter, randomized controlled trials of carotid revascularization and intensive medical management versus medical management alone in patients with asymptomatic high-grade carotid stenosis.

Inclusion • Patients ≥35 years • Stenosis ≥70% by catheter angiography (NASCET Criteria); OR by DUS with ≥70% stenosis defined by a peak systolic velocity of at least 230 cm/s plus at least one of the following: – an end diastolic velocity ≥100 cm/s, or – internal carotid/common carotid artery peak systolic velocity ratio ≥4.0, or – CTA with ≥ 70% stenosis, or – MRA with ≥ 70% stenosis.

Current Research Summary TIMELESS

PROST

ADVANCE

Study type

Interventional

Estimate enrollment

456

316

140

Allocation

Randomized

N/A

Intervention Model

Parallel assignment

Single group assignment

Masking

Quadruple

Single (outcome assessor)

None (open label)

Primary purpose

Treatment

Start date

March 2019

October 2019

April 2020

Estimated primary completion date

November 2021

December 2020

April 2024

Telestroke We offer 24/7/365 access to consultation with one of the nation’s leading comprehensive stroke programs. The highest level of telestroke coverage, interventional support and neurocritical care services are close by and only one call away.

By the Numbers

158% 24/7 increase in tPA utilization

200 mile radius

365

support

day cerebrovascular intervention and transport coordination

10%

bed dedicated neuro ICU

minutes maximum response time

transfer rate

Connect With Us for More Information 904.202.5328 telestroke@bmcjax.com

teleneurologists

telestroke partner sites currently served

Neurological Institute

Emergency Transfers: 904.202.BRAIN (2724) Fast-Access Office Appointments: 904.861.0316 Referral Fax: 904.384.1005