With recent studies confirming the benefits of some newer stroke treatments, how is the field of stroke care changing?
What does it mean for stroke patients?
Learn more from Dr. Avery Evans, a UVA interventional neuroradiologist who specializes in stroke care.
The Changing Face of Stroke Care
Featured Speaker:
Avery Evans, MD
Dr. Avery Evans is a board-certified radiologist who specializes in interventional neuroradiology procedures to treat strokes, cerebral aneurysms and arteriovenous malformations. Transcription:
The Changing Face of Stroke Care
Melanie Cole (Host): With recent studies confirming the benefits of some newer stroke treatments, how is the field of stroke care changing? My guest today is Dr. Avery Evans. He’s a board-certified radiologist who specializes in interventional neuroradiology procedures to treat strokes, cerebral aneurysms and arterial venous malformations. Welcome to the show, Dr. Evans. Tell us a little bit about some of the major developments in stroke care recently and describe them for the listeners.
Dr. Avery Evans (Guest): Well, as you mentioned, there have been some very exciting recent changes in stroke care. For a few years, we’ve had the ability to go in and treat some of the most devastating kinds of stroke, which is the ability to go in and remove a blood clot from a blood vessel in the patient’s brain. But up to now, we haven’t really been sure that this is the best thing for the patient, but four trials have recently come out that showed that unequivocally, this is a benefit to patients and more patients will get better if we do this than if we don’t.
Melanie: So that’s what it means for patients. Tell us a little bit about who could benefit from these developments.
Dr. Evans: Well, anyone can develop a stroke. It’s generally a disease of older patients, but it can happen in younger patients as well, but anybody can develop a stroke. The people who will benefit from this most are people who are having what we call ischemic strokes. This is a stroke that occurs because there has been blockage of a blood vessel in the brain.
Melanie: Tell us a little bit about ischemic stroke and what you’re doing. Is there a revascularization? Are we talking about first responder, what’s happening in the emergency room? Kind of go through it for us.
Dr. Evans: Well, one of the things I want to do is frame this for the people who are listening. Stroke is an incredibly important disease. Most people don’t realize that. It is the third leading cause of death in this country and it is the leading cause of disability. I think it’s sort of underappreciated by the general public. It’s a very important disease. What happens is a patient has signs and symptoms of a stroke and we can talk about what they are, and if we must, we’ll talk about them now. If you or a loved one is having weakness or numbness on one side of the body, if you’re having difficulty speaking or understanding speech, if you’re having a facial droop or difficulty seeing or blindness in one eye or the other or both, these are all very common symptoms with stroke, and the most important thing is that if you or a family member or a friend is having any of those symptoms, it’s incredibly important that you immediately call 911 or get that patient to the nearest emergency room because we have a saying among those of us who treat this disease, and that is, “Time is brain.” The longer you wait, the less likely it is that you’ll be able to have a good outcome if you’re having that kind of stroke. So it’s imperative that patients get to the hospital immediately. It’s the kind of thing, I think, because it doesn’t hurt—everybody understands if you have chest pain, you need to get to the emergency room—but stroke is not painful, and so I think because it doesn’t hurt, people think, “Well, Grandma doesn’t look exactly right. She’s a little weak, but we’ll just let her sleep it off.” That’s the wrong thing to do. If people are having signs and symptoms of stroke that I described, they need to get to the emergency room immediately. That’s the most important thing people listening to this need to hear.
Melanie: When we think about identifying it then, so time is brain, they spot some of these red flags you’ve described, they get to the emergency room, what do those people do to identify rapidly and accurately that it is a stroke and how fast can they start treating it?
Dr. Evans: We can start treating it very quickly. One of the great things about being here at the UVA is that we have all the pieces of the puzzle to make this happen properly. Make no mistake: it takes a team of people to make this happen. First off, you have to have the complex imaging equipment that it takes to diagnose the disease. Then you have to have people like me and some of my colleagues who have the ability to go in and remove the blood clot from the brain. Most importantly, it takes a team of specialized stroke neurologists which we have here at University of Virginia. We have a team of stroke neurologists who are on call 24/7/365. The minute the patient like this comes to the hospital, they jump into action and make the diagnosis. What happens is the patient comes in, the ER doctor identifies that the patient is having a stroke. The stroke neurology team jumps into action; they go and examine the patient. The patient very quickly is taken to the CT scanner. We do imaging of the brain and we’re looking to make sure that there is not already a completed stroke. We have to make sure that the damage hasn’t already been done. We also make sure that there hasn’t been bleeding because some kinds of stroke can present with bleeding. Then the stroke neurologist makes the determination whether they are going to give a clot-busting drug through the IV, that’s a clot-busting drug called tPA, so frequently they’ll give that. Then at that time, or before or after, we’ll do a specialized imaging study to find out if one of the large blood vessels in the brain is being blocked by a blood clot. If we determine that that large blood vessel is being blocked by a blood clot, then we can go in with some specialized tools, some catheter, some very long plastic tubes and some other specialized tools. With a high degree of success, we can remove the blood clot that’s blocking the blood vessel and restore flowing blood to the brain and hopefully prevent further damage. In a nutshell, that’s how it works, but it starts with a team. You’ve got to have a team of people who are experts in how to do this. No one physician group has all the expertise that it takes to do this.
Melanie: That’s absolutely fascinating. In addition to acting fast and your ability to go in there and get these blood clots and the medications, what are you seeing as outcomes and what can we do to prevent stroke in the first place?
Dr. Evans: Well, the outcomes from stroke with this new technique are better than they have ever been. The particular kind of stroke that we’re targeting with this is what we call a large vessel occlusion stroke. These are the strokes of large blood vessels of the brain that lead patients most to devastated. These are the kinds of strokes that just really totally devastate the patient. Now, sort of for the first time – well, we’ve been able to do it as I said for several years – but for the first time, we have absolute proof that it helps a lot of people, a lot more than we could have. It’s very exciting in that sense. It’s the biggest development we’ve had in stroke care in 20 years, it’s easy to say. As far as prevention is concerned, prevention mainly has to do with good medical care. You need to have a relationship with your primary care doctor. You need to make sure that if you need blood pressure medicine, that you’re taking it appropriately. You need to make sure that if you have high cholesterol that you’re treating that either through diet or through meds. So stroke care begins with patients taking good care of themselves, and that has to do with making sure that you get your annual checkups with your primary care doctor.
Melanie: Tell us in just the last minute your best advice for people listening who are worried about stroke, and what are the benefits of coming to UVA for their stroke care?
Dr. Evans: Well, as I said earlier, it takes a team to do this and we have all the pieces of the puzzle right here. Not very many hospitals in the country have all of that and we have it. We’ve got excellent primary care doctors. As I said, we’ve got a team of absolutely fantastic stroke neurologists on call 24/7 who will be there immediately the patient needs them, and we have a complex imaging equipment and also doctors like me who, if needed, can go in and remove these blood clots if they’re present. We have it all here. But it all begins with patients taking care of themselves, getting their annual checkups and making sure that they reduce their stroke risk factors as best they can.
Melanie: It’s great information. Thank you so much. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
The Changing Face of Stroke Care
Melanie Cole (Host): With recent studies confirming the benefits of some newer stroke treatments, how is the field of stroke care changing? My guest today is Dr. Avery Evans. He’s a board-certified radiologist who specializes in interventional neuroradiology procedures to treat strokes, cerebral aneurysms and arterial venous malformations. Welcome to the show, Dr. Evans. Tell us a little bit about some of the major developments in stroke care recently and describe them for the listeners.
Dr. Avery Evans (Guest): Well, as you mentioned, there have been some very exciting recent changes in stroke care. For a few years, we’ve had the ability to go in and treat some of the most devastating kinds of stroke, which is the ability to go in and remove a blood clot from a blood vessel in the patient’s brain. But up to now, we haven’t really been sure that this is the best thing for the patient, but four trials have recently come out that showed that unequivocally, this is a benefit to patients and more patients will get better if we do this than if we don’t.
Melanie: So that’s what it means for patients. Tell us a little bit about who could benefit from these developments.
Dr. Evans: Well, anyone can develop a stroke. It’s generally a disease of older patients, but it can happen in younger patients as well, but anybody can develop a stroke. The people who will benefit from this most are people who are having what we call ischemic strokes. This is a stroke that occurs because there has been blockage of a blood vessel in the brain.
Melanie: Tell us a little bit about ischemic stroke and what you’re doing. Is there a revascularization? Are we talking about first responder, what’s happening in the emergency room? Kind of go through it for us.
Dr. Evans: Well, one of the things I want to do is frame this for the people who are listening. Stroke is an incredibly important disease. Most people don’t realize that. It is the third leading cause of death in this country and it is the leading cause of disability. I think it’s sort of underappreciated by the general public. It’s a very important disease. What happens is a patient has signs and symptoms of a stroke and we can talk about what they are, and if we must, we’ll talk about them now. If you or a loved one is having weakness or numbness on one side of the body, if you’re having difficulty speaking or understanding speech, if you’re having a facial droop or difficulty seeing or blindness in one eye or the other or both, these are all very common symptoms with stroke, and the most important thing is that if you or a family member or a friend is having any of those symptoms, it’s incredibly important that you immediately call 911 or get that patient to the nearest emergency room because we have a saying among those of us who treat this disease, and that is, “Time is brain.” The longer you wait, the less likely it is that you’ll be able to have a good outcome if you’re having that kind of stroke. So it’s imperative that patients get to the hospital immediately. It’s the kind of thing, I think, because it doesn’t hurt—everybody understands if you have chest pain, you need to get to the emergency room—but stroke is not painful, and so I think because it doesn’t hurt, people think, “Well, Grandma doesn’t look exactly right. She’s a little weak, but we’ll just let her sleep it off.” That’s the wrong thing to do. If people are having signs and symptoms of stroke that I described, they need to get to the emergency room immediately. That’s the most important thing people listening to this need to hear.
Melanie: When we think about identifying it then, so time is brain, they spot some of these red flags you’ve described, they get to the emergency room, what do those people do to identify rapidly and accurately that it is a stroke and how fast can they start treating it?
Dr. Evans: We can start treating it very quickly. One of the great things about being here at the UVA is that we have all the pieces of the puzzle to make this happen properly. Make no mistake: it takes a team of people to make this happen. First off, you have to have the complex imaging equipment that it takes to diagnose the disease. Then you have to have people like me and some of my colleagues who have the ability to go in and remove the blood clot from the brain. Most importantly, it takes a team of specialized stroke neurologists which we have here at University of Virginia. We have a team of stroke neurologists who are on call 24/7/365. The minute the patient like this comes to the hospital, they jump into action and make the diagnosis. What happens is the patient comes in, the ER doctor identifies that the patient is having a stroke. The stroke neurology team jumps into action; they go and examine the patient. The patient very quickly is taken to the CT scanner. We do imaging of the brain and we’re looking to make sure that there is not already a completed stroke. We have to make sure that the damage hasn’t already been done. We also make sure that there hasn’t been bleeding because some kinds of stroke can present with bleeding. Then the stroke neurologist makes the determination whether they are going to give a clot-busting drug through the IV, that’s a clot-busting drug called tPA, so frequently they’ll give that. Then at that time, or before or after, we’ll do a specialized imaging study to find out if one of the large blood vessels in the brain is being blocked by a blood clot. If we determine that that large blood vessel is being blocked by a blood clot, then we can go in with some specialized tools, some catheter, some very long plastic tubes and some other specialized tools. With a high degree of success, we can remove the blood clot that’s blocking the blood vessel and restore flowing blood to the brain and hopefully prevent further damage. In a nutshell, that’s how it works, but it starts with a team. You’ve got to have a team of people who are experts in how to do this. No one physician group has all the expertise that it takes to do this.
Melanie: That’s absolutely fascinating. In addition to acting fast and your ability to go in there and get these blood clots and the medications, what are you seeing as outcomes and what can we do to prevent stroke in the first place?
Dr. Evans: Well, the outcomes from stroke with this new technique are better than they have ever been. The particular kind of stroke that we’re targeting with this is what we call a large vessel occlusion stroke. These are the strokes of large blood vessels of the brain that lead patients most to devastated. These are the kinds of strokes that just really totally devastate the patient. Now, sort of for the first time – well, we’ve been able to do it as I said for several years – but for the first time, we have absolute proof that it helps a lot of people, a lot more than we could have. It’s very exciting in that sense. It’s the biggest development we’ve had in stroke care in 20 years, it’s easy to say. As far as prevention is concerned, prevention mainly has to do with good medical care. You need to have a relationship with your primary care doctor. You need to make sure that if you need blood pressure medicine, that you’re taking it appropriately. You need to make sure that if you have high cholesterol that you’re treating that either through diet or through meds. So stroke care begins with patients taking good care of themselves, and that has to do with making sure that you get your annual checkups with your primary care doctor.
Melanie: Tell us in just the last minute your best advice for people listening who are worried about stroke, and what are the benefits of coming to UVA for their stroke care?
Dr. Evans: Well, as I said earlier, it takes a team to do this and we have all the pieces of the puzzle right here. Not very many hospitals in the country have all of that and we have it. We’ve got excellent primary care doctors. As I said, we’ve got a team of absolutely fantastic stroke neurologists on call 24/7 who will be there immediately the patient needs them, and we have a complex imaging equipment and also doctors like me who, if needed, can go in and remove these blood clots if they’re present. We have it all here. But it all begins with patients taking care of themselves, getting their annual checkups and making sure that they reduce their stroke risk factors as best they can.
Melanie: It’s great information. Thank you so much. You are listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.