When Stroke Strikes

Arroyans, rejoice! You may never need the impressive new state-of-the-art stroke center at Huntington Memorial Hospital, but just having it here enhances the community’s quality of life. The sobering reality is this: You may think you’re immune to stroke because you’re healthy, young, athletic — or all the above. But stroke can strike anyone AT any age, from childhood on. One in every six Americans will experience one; it’s the country’s leading cause of disability and the third leading cause of death, says Dr. Arbi Ohanian, medical director of Huntington’s new stroke program.

Ohanian, 37, is one of only a few neurologists in the nation who is board-certified and fellowship-trained specifically in the treatment of stroke. It’s an emerging medical subspecialty for an ailment that, until five years ago, had no known treatment or cure. Doctors could do nothing but wait until the crisis passed, then prescribe physical therapy to help mitigate the stroke’s debilitating after-effects.

All that has changed, Ohanian says. Recent advances in technology, treatment and the standard of care can now make strokes survivable and prevent their most devastating consequences. These cutting-edge advances are in place at Huntington, the only hospital in the San Gabriel Valley to win the Joint Commission’s designation as a Primary Stroke Center; the Illinois-based nonprofit awarded the Pasadena hospital its Gold Seal of Approval last month. (Until  two years ago, there was only one Primary Stroke Center in the Los Angeles area; now there are nine.)

When stroke strikes, the first responders are often local paramedics, who have been trained to recognize symptoms and take patients to a Primary Stroke Center if it is less than 30 minutes away. If they’re in the greater Pasadena area, they alert Huntington as soon as possible to let the hospital know they’re on their way. That’s because speed is crucial in treating stroke. “From the instant a stroke starts, you lose 2 million brain cells a minute — every minute,” Ohanian says.

Many fitness buffs think they’re invulnerable to a stroke, but that’s a dangerous assumption, he says. A recent patient is a 33-year-old certified scuba diver, skydiver and professional movie stuntwoman. Now back at work, she arrived at Huntington in a condition that would have been fatal or severely disabling if she’d done what many young or athletic people tend to do: “They wait to see if the symptoms subside,” Ohanian says. “Then they drive to an urgent-care facility or nearby hospital emergency room, where they fill out papers and wait their turn to be seen. They almost always wait to get a CAT scan, because other patients are scheduled ahead of them. A neurologist may not be available for hours.”  When stroke is finally diagnosed, which could be the next day, the patient is often transferred to another facility where better stroke care can be offered. Outcomes in such cases are far less than optimal, the doctor says.

The Primary Stroke Center designation came about to prevent such needless loss of time and life. “In recent years, the stroke community recognized that we need a more standardized way to ensure more timely and efficient care,” he adds. Although not all of L.A.’s Primary Stroke Centers have the exact same equipment and procedures in place, all have demonstrated that within 60 minutes of patient arrival, they can provide clot-busting medication and meet all national stroke care guidelines. At Huntington, procedures and care far exceed those mandated guidelines, Ohanian says. One example: A new 10-bed neurosciences stroke unit which opened in May, 2009, staffed by nurses who specialize in stroke management.

When a stroke victim arrives at Huntington, not a moment is lost. A “code stroke” is immediately activated, and a diverse team of specialists convenes. “When a code stroke is called, my pager goes off, the CAT scanners’ pager goes off, the phlebotomist’s pager goes off,” explains Ohanian. “The phlebotomist quickly draws the patient’s blood. The stroke neurologist provides a consultation within five minutes. If there’s another patient on the scanner, they’re immediately taken off to make room for the stroke patient. The neuroradiologist immediately reviews the images.” 

Huntington’s scanner — the most advanced currently available — sets the hospital apart in the region. “No other hospital in L.A. has one, and I believe we’re the only one on the West Coast with one of these,” says Ohanian, adding that it just became operational in July. To put the new technology in perspective, he adds, “scanners at most medical centers are 64 slices. Ours is 320 slices. The more slices, or detectors, you have, the better resolution you get.

Scanners tell us the tissue status; they detect what tissue has died off and what is still at risk. They tell us where the actual vessel blockage is. This new machine gives much faster and far better information than older scanners — and it also emits
less radiation.”
Next, the stroke specialty team collaborates to decide the course of treatment. “Ischemic strokes are caused by blood clots to the brain. Hemorrhagic strokes are caused by bleeding into the brain,” Ohanian explains. Available treatments are extremely time-sensitive. “A clot-busting medication, given through the vein, must be delivered by doctors who know enough to give it, and to give it in time.”

Huntington also differs from other some other medical centers, he says, in offering the newest interventional treatments available. “These procedures must be done by a neurosurgeon and neuroradiologist who go in with a catheter through an artery in the leg and navigate from there up into the blood vessels of the brain. They accomplish this with very recently developed devices.”

One of these is MERCI, a corkscrew device that enters the blood clot in the brain and tries to retrieve it. The Penumbra is also used for clot removal, but it uses suction. “You have to bear in mind that these blood vessels from which the clot is being removed are tiny, less than 3 millimeters in diameter,” Ohanian explains. “And these are extremely specialized procedures with high potential risks, so they require a comprehensive, highly specialized team approach.” In other words, it takes a village of diverse and skilled specialists to diagnose and treat a stroke patient using these methods within a very short period of time.

With all its cutting-edge elements, Huntington’s program gives stroke patients a greatly increased chance of complete recovery. One such fortunate patient is A. Franklin Turner, president of  Arcadia Radiology. Turner’s wife had heard about Huntington’s stroke program and attended a lecture by Dr. Ohanian. “I told her not to bother with that lecture,” Turner recalls with a chuckle. “I’d had heart attacks, but never a stroke. She said, ‘We’re both 80 and should know the signs and how to help ourselves and our friends.’”

She was right. On June 9, Turner awoke paralyzed on one side. His wife dialed 911 and told the dispatcher she thought he’d had a stroke. “The stroke team met me at the door, ready for action. They were unbelievably well coordinated and organized. I am still astounded by the speed and efficiency of all that happened. The first week I was on the acute floor, in the special stroke section. The second week you get vigorous therapy. All sorts of specialists see you from day one and every day after.

“They asked me what my goal for recovery was. I said I want to be back at work in one month. They said that’s a bit overly optimistic, that seven months was usual in a case like mine. But they said if one month was what I wanted, they’d work with me to try to achieve it. And they did. I was back at work one day short of a month.”

These days, Turner likes to spread the word about Huntington. “I tell people there’s no place like it. If you feel sick, don’t let them take you anywhere else.”