THE QUARTERLY NEWSLETTER OF THE NEUROVASCULAR STROKE CENTER AT THE OHIO STATE UNIVERSITY SPRING 2012 FROM THE EDITORS Michel T. Torbey, MD, MPH, FCCM, FAHA Professor of Neurology & Neurosurgery Medical Director, OSU Neurovascular Stroke Center Welcome to the first edition of Stroke Alert, the official newsletter of the Neurovascular Stroke Center at the Ohio State University. Stroke Alert is a quarterly publication intended for medical professionals as well as the community at large. This newsletter will keep you updated on the recent developments at the OSU Neurovascular Stroke Center in the realm of clinical innovations, research, education, and community service. We, at the OSU Neurovasuclar Stroke Center, firmly believe that prevention of stroke begins with education. Our aim is to raise awareness of the devastating impact of stroke on community health and what our center has to offer to reduce that burden. We hope that you find Stroke Alert helpful in that regard. Réza Behrouz, DO, FACP Assistant Professor of Neurology Eric Sauvageau, MD Associate Professor of Neurosurgery Surgical Director, OSU Neurovascular Stroke Center The Ohio State Neurovascular Stroke Center is the home of the most comprehensive team of stroke specialists in central Ohio. We are a certified Joint Commission Primary Stroke Center for Michel our long-term, T. Torbey, documented MD, MPH, FCCM, success FAHA in delivering high quality stroke care. Our goal is to minimize the impact of stroke and maximize the quality of life for our patients. Our team is available in-house 24/7 to respond to any stroke emergency Over the last year our program has experienced significant growth. Our physician team consists of 5 board certified vascular neurologists, 4 board certified neuro-intensivists, and two dually trained vascular and endovascular neurosurgeons placing our team among the largest multidisciplinary teams in the country. Our physicians are well renowned clinician scientists with significant track records of research and national recognition. As part of our commitment to provide rapid access for our EMS and referring hospitals, we developed the Stroke Alert phone line (366-8111). We also have extended the stroke treatment window to 24 hours to make sure all patients have a chance at potential therapy. In its inaugural year, our state-of-the art Telestroke program has grown from three hospitals to thirteen. This has given our rural and community hospital partners the ability to bring the OSU stroke experts to the bedside within minutes. SIMPLY, OHIO STATE UNIVERSTY S STROKE CENTER IS YOUR BEST CHOICE FOR THE TREATMENT OF ANY BRAIN EMERGENCY 1
Martha A. Heath, RN, MS, MEd, CCRN, CNRN, CCNS, ACNP-BC, CNS, CNP Neurovascular / Neurosurgery Nurse Practitioner OSU Neurovasuclar Stroke Center NEUROVASCULAR NURSING Stroke is an emergency time is brain. Nurses are often expected to provide frequent neurological assessments to evaluate subtle changes from an expected baseline of deficits. The time we spend caring for and assessing our patient is critical. The role of a neuroscience nurse is vital in detecting subtle changes in a patient's examination that can be lifealtering. Therefore, we will focus on areas related to communication, documentation, evaluation and assessment techniques. That being said, this is an exciting time to be involved in stroke and the care of patients at risk for, and suffering from cerebrovascular disease. Wexner Medical Center and the Departments of Neurosurgery and Neurology have embraced this endeavor with enthusiasm and zeal. As a result, the Neurocritical Care Team and Neurovascular Stroke Program have been formed. This inaugural edition of the Stroke Alert is one part of this exciting process. As a Neurovascular Nurse Practitioner, I have witnessed significant growth with evidence-based interventions in endovascular treatment that have translated into the reversal of stroke symptoms! I have had the pleasure of being trained and working at several top Neuroscience programs in the country at the University of California San Francisco and Stanford University Medical Center. During my tenure there, I obtained key skills in early assessment and intervention of stroke. I am excited to work with such an esteemed team of providers here at Ohio State University and am available anytime to answer questions. Please join me in congratulating our staff on the inaugural addition of Stroke Alert. Neurological Assessment for Stroke An important evaluation tool nurses have is the scale endorsed by the National Institute of Health known as the NIHSS (National Institute of Health Stroke Scale). NIHSS is a standardized method used by physicians and other health care professionals to measure the level of impairment caused by a stroke. The NIHSS serves several purposes, but its main use in clinical medicine is during the assessment of whether or not the degree of disability caused by a given stroke merits treatment with t-pa, a thrombolytic. Another important use of the NIHSS is in research, where it allows for the objective comparison of efficacy across different stroke treatments and rehabilitation interventions. The NIHSS measures several aspects of brain function, including consciousness, vision, sensation, movement, speech, and language. A certain number of points are given for every impairment uncovered during a focused neurological examination. A maximal score of 42 represents the most severe and devastating stroke. Current guidelines, as of 2008, allow strokes with scores greater than 4 points to be treated with t-pa The level of stroke severity as measured by the NIH Stroke Scale scoring system: 0= no stroke, 1-4= minor stroke, 5-15= moderate stroke, 15-20= moderate/severe stroke, 21-42= severe stroke To become NIHSS certified, you may visit the following website: http://learn.heart.org/ihtml/application/student/interface.heart2/nihss.html. 2
QUALITY CARE AT OSU NEUROVASCULAR STROKE CENTER This project, conducted by the nursing staff at the OSU Neurovascular Stroke Center, demonstrated that after administration of IV tpa, patients can be safely monitored in our progressive care unit and receive the highest quality of care. As indicated above, the no patient needed to be transferred to the intensive care unit after being cared for in the progressive care unit. The project was presented at the American Association of Neuroscience Nurses (AANN) 44th Annual Educational Meeting in Seattle, Washington April 28 - May 1. It won the second place at this national conference. Dorina Harper, MS, RN, ACNS-BC, CCRN (right), Neurovascular Unit Clinical Nurse Specialist presenting the poster at the AANN, Seattle, WA 3
CLINICAL TRIALS Clinical Research at OSU allows our stroke team to stay up to date on the cutting edge of medicine. We have a vast array of different clinical research studies for each unique patient. Condition Study Name Recruitment Purpose of the Study Acute ischemic stroke ALIAS II Ages 18-83 Interventional: To determine whether high dose human albumin acts as a neuroprotectant when given within 5 hours of symptom onset Acute ischemic stroke DIAS IV Ages 18-85 Interventional: To evaluate the effectiveness of desmoteplase versus placebo in patients with acute ischemic stroke within 3-9 hours of symptom onset. Acute minor ischemic stroke and TIA POINT Age 18 or older Interventional: To determine whether clopidogrel (Plavix) 75mg/day after a loading dose of 600mg of clopidogrel is effective in preventing major ischemic vascular events (like stroke and heart attack) at 90 days in patients receiving aspirin 50-325mg/day. Acute hemorrhage CLEAR III Ages 18-80 Secondary stroke prevention Secondary stroke prevention IRIS RESPECT Age 40 or older Enrollment completed Intracranial Aneurysms HEAT 18-75 Intracranial Aneurysms ASPIRe Older than 22 Interventional: To define the long-term effects of breaking up ventricular blood clots with rt-pa on the functional outcomes of patients presenting with severe intraventricular hemorrhage. Interventional: To test the effectiveness of a new treatment (pioglitazone) for preventing future strokes and heart attacks among patients with a recent stroke. Interventional: To investigate whether percutaneous Patent Foramen Ovale (PFO) closure, using the AMPLATZER PFO Occluder, is superior to current standard of care medical treatment in the prevention of recurrent embolic stroke. To test the effectiveness of a new generation FDA approved device for treating aneurysms compared to the current standard device for endovascular aneurysm treatment which is bare platinum coils. To further expand the body of clinical knowledge in patients undergoing Pipeline Embolization Device (Pipeline or PED) placement for intracranial aneurysms (IAs or ICAs) according to Pipeline's labeled indication. Acute Ischemic Stroke from Large Vessel Occlusion - 18-85 To compare the safety and effectiveness of the Penumbra System with and without the Separator 3D for the revascularization of large vessel occlusion. 4
TIME IS BRAIN A JOURNEY INTO TELEMEDICINE In the summer of 2011, the Wexner Medical Center, under the direction of Dr. Michel Torbey, Medical Director of the Neurovascular Stroke Center, went live with 3 hospitals to start its telestroke network. With the support of a grant from the Ohio Department of Health and technology based resources, we have put the faces and the knowledge of our vascular trained neurologists in to remote hospital emergency rooms to evaluate patients and discuss treatment options with stroke patients and their local ED physicians. This technology has helped provide astute assessment and treatment to patients who could have otherwise been outside treatment window by the time of a transfer to a larger hospital was possible. It has also provided patients with options in endovascular neurosurgery that would have otherwise not been possible. This specialized, physician-led feedback also has kept some patients closer to home by evaluating their symptoms real-time in the ED. In its first year, the program has grown to serve over 180 patients from different hospital locations. The hospital training has led to improved workflow between all departments, a formalized use of order sets, increased competency of nurses in using the NIH Stroke Scale and successful collaboration with physicians and staff to deliver treatment decisions within a 60 minute-door-to-decision timeframe. Improved stroke care throughout the state is our goal. Through strategic endeavors to promote improved stroke care, the program will be supporting a 13 spoke hospital system by fall of 2012. 5
FACULTY HIGHLIGHT Congratulations to Dr. Ciaran Powers, OSU assistant professor of neurosurgery. Dr. Powers was awarded the Davis-Bremer award to study mir profiling of SAH patients. The Davis/Bremer grants are offered by the College of Medicine and Public Health once per year to newer MD faculty who are just starting out in their research careers. The Ohio State University Neurovascular Stroke Center 395 West 12 th Avenue 7 th Floor Columbus, Ohio 43210 (614) 293-4969 http://neurology.osu.edu/stroke/nvsc.html 6