KMC Hits Rare Triple in Stroke Care, Restores Three Lives in One Day

"This is incredibly rare," said Nancy Wiech, stroke case manager who was on duty when the three patients came in on July 16. "I wouldn't be surprised if it were the only time this happened this year in Ohio. All three came in unable to speak and, thanks to the t-PA, they were all discharged from the hospital with their speech restored and without any major deficits."

T-PA is given only to ischemic stroke patients, meaning their stroke is caused by a clot or plaque. Tissue plasminogen activator (t-PA) is never given to hemorrhagic stroke victims whose strokes involve brain bleed, as it would cause worsening of their condition and brain bleeding that could result in death. A simple CT image can detect brain bleeding or other findings that are contra-indications for treatment with t-PA.

A history, assessment and neurological exam is performed by the neurologist who makes the decision as to whether the drug can be used. The drug is usually given within three hours of symptom onset, but a recent study demonstrated t-PA may be of benefit and given safely up to 4.5 hours after symptom onset.

Specific criteria must be followed, though, excluding some patients. Nationwide, less than five percent of ischemic stroke victims ever get the drug. In the first seven months of this year, 9.6 percent of Kettering/Sycamore's ischemic stroke patients have received it.

"We've given two t-PAs in a single day, but never three before this," said Ken Pugar, DO, neurologist. "We're giving them in numbers on pace with a university center. This may not have happened 4-5 years ago, and I think we are getting more opportunities due to better recognition of stroke symptoms, recognition of the fact that stroke is an emergency and better response times from EMS personnel."

Kettering has treated 22 patients with t-PA in the first eight months of 2009, already tying the number given in all of 2008. "There is better awareness, and I do feel like people come in when they notice symptoms a little sooner because of all the patient education and media attention that has been out there," Wiech said. "Many clinicians from other hospitals have indicated how impressed they are with how many patients we treat with t-PAs here."

Kettering and Sycamore are certified by the Joint Commission as Primary Stroke Centers, indicative of the high quality of care. The medical centers were Silver Award winners in American Stroke Association's "Get With the Guidelines" recognition, published nationally in U.S. News and World Report this past July.

"We have a coordinated stroke team that springs into action each time a patient presents with stroke symptoms," Dr. Pugar said. "It requires EMS, physicians, nursing, radiology, pharmacy, laboratory and therapists all coming together. The Kettering/Sycamore stroke team is very proud of what it has accomplished in recent years. In fact, in the past five years we have given t-PA to 20 or 30 percent more of our eligible patients than other Stroke Centers of Excellence have. That says something."

"It is so rewarding for us to see how these three patients improved after the t-PA treatment," Wiech said. "They recovered completely, and were so grateful for restoring their independence and speech. T-PA works wonders in some patients, and is the only FDA approved drug for stroke. It is a shame that more people in our country don't get the chance to benefit from it."

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