ENC Features
11:58 am
Fri March 29, 2013

Combating North Carolina's High Stroke Rate

A feature report on the latest advancements in the treatment of strokes.

Stroke – it’s feared, its deadly, and it’s debilitating.  As far as statistics are concerned, you’re more likely to have a stroke if you live in the South.  In fact, stroke is the third leading cause of death in North Carolina.  And our state is considered to be the ‘buckle’ of the stroke belt, which includes several states in the southeast part of the country where stroke death rates are significantly higher than the rest of the United States.

“We’re experiencing strokes at least two times higher than the rest of the country.”

Margaret Rudisill is the Program Director with the North Carolina Stroke Association.

 “we’re not really sure why that is.  It’s been like that for thirty years.”

Every twenty minutes in North Carolina someone is hospitalized with a stroke and every two hours, someone dies from a stroke.  Rudisill says knowing the symptoms and getting help as soon as possible greatly decreases the chance of death and disability. She adds the best way to prevent a stroke is by simple lifestyle changes, such as eating healthy foods and getting plenty of exercise.

“We have made strides in blood pressure treatment.  If we haven’t been following up with physicians, and if we’re not going to change our lifestyle, it’s a time bomb.  Most people do want a pill to treat everything because it’s the easiest thing.”

Stroke is claiming less deaths every year, thanks to technological breakthroughs in the scientific and medical communities. Every year, there are 208,000 living survivors of stroke in North Carolina.

The number one goal of treating a stoke patient is restoring the blood flow to the brain.  Two new devices are being used to help reopen blocked arteries called the solitaire flow restoration device and the Trevo device.  They both operate similar to a stent that opens up heart arteries.  However, the devices are smaller, more flexible and are only temporary.

“These devices have been a really great advance for us allowing us to do these procedures more successfully, more efficiently, faster and much safer than we were able to do them before.”

That’s Dr. David Fiorella.  He is a professor in neurosurgery and neuroradiology at Stony Brook University Medical Center in Long Island, New York.  They’ve been using both devices for about a year, and have performed 50 to 60 successful procedures. 

“when the patient comes to us with a blocked artery in the brain, we under x-ray guidance, using very sophisticated x-ray equipment drive our catheters very delicately across the area of the blockage.  We can then put these stent retriever type devices like the Trevo and solitaire, we thread them through these tiny catheters that are in the brain and across the area of the blockage.”

Once the stent retriever device is delivered to the area of blockage, surgeons pull back its micro catheter as the stent expands into a cylindrical tube. 

“And basically as it expands, it pushes the clot material out of the way and immediately restores blood flow to the brain.”

Once blood flow is normal, the Trevo or Solitaire device is removed within minutes.

 “Once we pull that out, often times typically we’ll pull the clot with it, removing what’s left of the clot from the brain artery leaving an open artery.”

Dr. Fiorella says the latest figures show a 90 percent success rate for the procedure.  The Trevo or solitaire flow restoration devices are administered by trained neurosurgeons, so only a handful of medical centers have implemented these devices.  Here in eastern North Carolina, Vidant Health in Greenville is using the technology.  Neurosurgeon at East Carolina University's Vidant Medical Center Hilal Kanaan.

"And so from a technical standpoint, the device is very straightforward to deploy and between me and my partner Dr. James we have a 100 percent success rate in opening up the blood vessel.  But that doesn't mean 100 percent of patients have done well from the procedure because whether we were able to save brain or not was the issue.  So our success rate, it's pretty comparable to national trends, a 50 to 60 percent chance that we will open up the blood vessel and improve neurologic function."

Vidant Health and Onslow Memorial Hospital are the only two hospitals in coastal North Carolina with a dedicated stroke center.  Each year, Onslow Memorial treats close to 600 stroke patients.  While the hospital isn’t using a stent-like clot removing device, they are administering a drug called tPA, or tissue plasminogen activator, which breaks down blood clots.  Josephine Malfitano is the Performance Improvement & Accreditation Manager at Onslow Memorial. 

“tPA drug is very effective. As a matter of fact, we had two patients back to back this past week and both of those folks will either have minimal or no long term rehabilitation.”

Program Director with the North Carolina Stroke Association Margaret Rudisill agrees, saying tPA is more readily available than other stroke treatment options.

“we can administer a drug called tPA, and even rural hospitals, you don’t have to go to a huge medical center to do that, can have the capability to do that and it is a miracle.”

Rudisill, who also serves as the Stroke Coordinator at Stanly Regional Medical Center in Albermarle, North Carolina says the chances of someone surviving a stroke and decreasing the amount of time spent rehabilitating goes up significantly if they receive the tPA drug within four and a half hours of the stroke.

“Time is brain, that’s our mantra.  If they sit and wait until tomorrow to see if they’re going to get better, it’s too late. We just had one this week that got here in the time frame, they were totally paralyzed on one side and couldn’t speak, we gave them the medicine and that person is walking out of the hospital today two days later after experiencing that huge stroke.”

Onslow Memorial Hospital is unable to provide the Solitaire Flow Restoration device or Trevo device because they don’t have a neurosurgery department.  Performance Improvement & Accreditation Manager Josephine Malfitano says if a patient needs this procedure, they are transferred to Vidant Health which is about 60 miles away.

Onslow Memorial provides rehabilitation services for stroke patients.  Inpatient Therapy Supervisor Doug Combs.

“in terms of physical therapy, we usually assist with walking and balancing retraining, as well as general strength training particularly on the patient’s affected side. As far as occupational therapy, they assist with ADLs, activities of daily living, such as dressing, bathing, eating, and cooking.  And then speech therapists are usually involved with helping with swallowing and/or speaking or mental processing issues.”

Stroke is a leading cause of serious long term disability and there is currently no drug treatment for post-stroke rehabilitation.  According to Science Daily Research News, a new study from Creighton University School of Medicine, Scripps Institution of Oceanography and The University of North Carolina Wilmington found that brevetoxin-2, a compound found in marine algae can stimulate nerve cell growth and plasticity in cultured mouse neurons.  Director of Marine Science at UNC Wilmington Daniel Baden says the compound is commonly referred to as Red Tide.

“The brevetoxin, brevetoxin-2 specifically, are natural products that are produced by the Florida red tide dinoflagellate karenia brevis. They occur on the west coast of Florida, Gulf of Mexico through to Texas. And form blooms known as Red Tides.”

The Marine Biotechnology in North Carolina facility at UNCW cultures more than a thousand ocean organisms for biomedical research, including brevetoxin. Baden says the algae could be used to develop a drug for people recovering from stroke.

“And that’s what it’s all about, taking the molecules, whatever the molecule is, whatever organism we have, whatever one we’re studying and look at how it acts on a molecular level. And then say what disease states do we know that these molecules could be applied to that would presumably reverse the effect on the disease state on a molecular level by treatment with these molecules.”

Baden says they have many more tests to run, and a drug for stroke victims is still about 10 years away. 

While eastern North Carolina remains the place where the highest number of stroke deaths occur, it’s also where the latest treatment and technology is being used to help stroke patients, and where ground breaking discoveries are taking place.  Still, experts say the best way to safeguard yourself against having a stroke altogether is by eating healthy foods, getting plenty of exercise, and not smoking.  Jared Brumbaugh, Public Radio East.