Lehigh Valley Hospital gets top stroke care designation

(Morning Call) When an emergency room doctor at Westfield Hospital informed Kim Sidor she had likely suffered a life-threatening stroke in June 2011, Sidor put her life in the hands of specialists at Lehigh Valley Hospital-Cedar Crest.

Sidor, an amateur runner who was training for her first marathon, had a ruptured artery in her brain. Her blood pressure was soaring. Saving her life would require quick action.

She had a couple of advantages. She was in otherwise good health. She first felt the onrushing, crushing headache at a gym close to Westfield, where she also works. Sidor also was accompanied by a friend who is a nurse.

With time of the essence, those advantages helped get Sidor within a few hours of the onset of the symptoms of the aneurysm to LVH.

That’s where perhaps her biggest advantage was. Sidor was seen in an emergency room by specialists trained for stroke patients and was operated on by Dr. Darryn Shaff, a neurointerventional radiologist. She then received care in a neurological intensive care unit from a staff dominated by nurses certified in neuroscience.

That kind of specialized care, using state-of-the-art equipment — and getting a positive outcome — is why LVH last month received accreditation from the Joint Commission as a ComprehensiveStroke Center. The Joint Commission, an independent accreditation agency, upgraded LVH’s designation from Primary Stroke Center.

“I think the accreditation now indicates to the community, indicates to health care professionals, to EMS, [which] hospitals are able to deliver complex care according to stringent comprehensive national standards,” Shaff said.

If the distinction sounds like a simple name change, consider this: When the Joint Commission designated LVH a Comprehensive Stroke Center, it was only one of five nationwide, and the only hospital east of the Mississippi to be named one.

It also identified a significant health concern in Pennsylvania. The state Department of Health says stroke is the third-leading cause of death among women and the fifth-leading cause for men, resulting in an average of 18 deaths every day in 2010.

LVH has been building to its new designation for years, said Dr. Yevgeniy Isayev, director of LVH’s Stroke Center. It starts with physicians like himself who receive additional training and certification as stroke neurologists.

“Very few centers can afford to have one stroke neurologist,” Isayev said. “We have four stroke neurologists, trained and certified.”

To receive the certification, the center has to have a full stroke team on-site at all times, including trained rehabilitation specialists. “In the past,” Isayev said, “if you had a stroke on Friday, good luck to see physical therapy by Monday or Tuesday.”

The care for stroke patients is advancing rapidly, too. Using advanced surgical techniques and imaging, doctors can treat patients by making a small incision in the groin and directing tiny equipment through the arteries into the brain.

That’s what they did for Sidor. Shaff delivered a packet of tiny wires, coiled into a small ball, and inserted it where Sidor’s artery had ruptured.

“Old days, 80 percent of these patients, we’d take off your skull, push your brain apart and dissect down and fix that blood vessel,” said Claranne Mathiesen, director of medical operations.

The less invasive technique allows for patients with blockage or ischemic strokes to be discharged after four to five days, Isayev said. For patients such as Sidor, who had a bleeding or hemorrhagic stroke, a two-week stay in the hospital is the norm, he said.

But being a comprehensive center means access to a wider variety of treatments, including invasive measures. Dr. Mark Li, chief of neurosurgery, said the vascular route may not be appropriate for some patients. He can still improve blood flow to the brain by taking a tiny artery from the scalp, cutting through the skull and surgically sewing the artery to the brain.

“So what Comprehensive Stroke is doing for us is it’s raising the standard for us in order that we can salvage [the] brain in as little time as possible,” Li said. “The time element is going to be key. So we’re applying technology along with protocols in order to get patients into these all of these therapies much more rapidly.”

After surgery, patients are watched in the 14-bed neuro-ICU, where the majority of nurses are specially trained in neurological care. “A patient with a stroke can get worse any time, particularly for the first week or two,” Isayev said. “Those patients are very carefully monitored by the nurses there who know … the signs of the worsening.

“We as physicians are used to taking care of the acute portions,” Isayev said, “[and] not always geared up to take care for the not-so-acute portion of the care.”

Comprehensive Stroke Centers also are required to do research. That benefits patients because access to clinical trials gives them an early opportunity to be involved in new therapies that have led to improved outcomes for stroke patients.

Isayev said only a few years ago, doctors could treat a stroke victim completely if they got to him within three hours. “Because of the research, we extended the window to 41/2 hours,” he said, adding that the window can stay open even longer than that if the conditions are favorable.

Besides the roughly 1,500 stroke patients they see each year, LVH doctors also provide “telestroke” consultations with doctors at other hospitals. That allows them to extend their expertise to other patients without necessarily transferring them.

But when those patients’ needs exceed the capabilities at those hospitals, they go to LVH. “We are taking care of the sickest of the sick,” Isayev said.

LVH stroke teams also are able to treat patients before one hits. On a recent weekday, Shaff operated on a man who had been hearing “swishing sounds” inside his head and was found to have been at high risk of a stroke. He was helped with the application of a substance that hardens like a glue inside the artery, Shaff said.

The doctors said more improvements will come, comparing today’s stroke care to where heart care was 25 years ago, before bypasses, catheterizations and minimally invasive surgeries became common. “So the number of big open heart surgeries has gone down, survival rates and quality of life rates have gone up,” Li said.

Sidor’s story illustrates the possibilities. After having her aneurysm repaired, she had to return twice to LVH for follow-ups, not only to monitor the initial surgery, but also to take some of the pressure off the site, since she has high blood pressure.

Sidor also says she continues to suffer from headaches, although Shaff said surgically induced headaches are rare. Shaff said he’s not sure what is causing her headaches, but Sidor said she’s able to control them with over-the-counter pain relievers.

In any case, they’re not slowing her down.

It may have been against Shaff’s recommendations, but on Oct. 28, not even 14 months after an artery burst in her brain, Kim Sidor ran her first marathon, finishing the Marine Corps Marathon in 5 hours, 30 minutes and 43 seconds.