John Gaughen, MD
Sentara in the Community

Stroke Care Takes Flight in the Blue Ridge Region

Sentara Martha Jefferson and Sentara RMH Partner With AirCare5 to Provide Medevac Service for Stroke Patients

When it comes to caring for stroke patients, the saying goes: Time is brain. Prompt treatment is critical for saving brain cells and improving a patient’s chances of recovery.

Stroke occurs when blood flow to the brain is cut off by a clot or by the rupture of a blood vessel in or around the brain. When brain cells are deprived of an oxygen-rich blood supply, they die, often resulting in permanent damage that may lead to disability or death. In fact, stroke is the fifth-leading cause of death in the United States and a leading cause of disability, according to the American Stroke Association. And anyone, regardless of age, race or gender, can have a stroke.

“Stroke is one of the most time-sensitive disease processes that we have to treat,” says John Gaughen, MD, a neurointerventional surgeon at Sentara Martha Jefferson. “Two million brain cells die every minute during a stroke, so there is no time to lose in treating stroke patients.”

Building a Helipad

After recently expanding its capabilities to include a promising new interventional treatment for stroke, Sentara Martha Jefferson has partnered with Sentara RMH Medical Center to offer air ambulance service for stroke patients via Sentara Martha Jefferson’s new helipad. The service will allow faster transport from Harrisonburg to Charlottesville for stroke patients who may be able to benefit from Sentara Martha Jefferson’s innovative treatments.

“The helipad complements a new lifesaving service at Sentara Martha Jefferson,” says Marijo Lecker, vice president for clinical programs in Sentara’s Blue Ridge Region. “Transporting a patient by road from Sentara RMH to Sentara Martha Jefferson takes about an hour, and that’s just too much precious time lost for a stroke patient. Now, the air ambulance service allows us to transport patients in about 14 minutes. This shortened response time is critically important for the successful treatment of stroke patients coming to Sentara RMH who need this service.”

Plans for the helipad started about a year ago. Officials at Sentara Martha Jefferson submitted a proposal to the Federal Aviation Administration and then followed the agency’s requirements during construction, which took about three months. Located just outside the hospital’s Emergency Department, the helipad opened in July 2016.

The air ambulance service is provided by AirCare5 Medevac, which operates out of Shenandoah Valley Regional Airport in Weyers Cave. AirCare5’s helicopter is outfitted with advanced medical equipment and staffed by highly trained personnel who care for patients in flight, until they transfer them to caregivers at Sentara Martha Jefferson. The service is available to patients coming from Sentara RMH, as well as from other locations throughout Central Virginia.

When a patient comes to Sentara RMH with symptoms of stroke, he or she will be evaluated by a neurologist and undergo a series of tests, including a computed tomography (CT) angiogram. The CT test allows doctors to see arteries in the body and determine whether a patient has a clot in a blood vessel in the brain. If a clot is detected, the medical team at Sentara RMH will then determine whether the patient should be transferred for specialized care at Sentara Martha Jefferson.

“If we think the air ambulance service is appropriate for the patient, based on imaging results, then our goal is to get them to the angiography suite at Sentara Martha Jefferson as quickly as possible and remove the clot immediately,” says Fouzia Siddiqui, MD, FCPS, stroke medical director for Sentara RMH. “The medevac service gives patients the option to remain in the Sentara Healthcare system for stroke treatment, where they can expect to receive personalized, compassionate care.”

Neurointerventional Services for Stroke

The standard of care for certain types of strokes, neurointerventional treatments involve a minimally invasive, catheter-based procedure to remove a blood clot in the brain.

Another treatment option, the clot-busting drug known as tissue plasminogen activator (tPA), is effective for some patients but has limitations, according to Dr. Gaughen. First, tPA must be given within three hours of the onset of stroke symptoms, and many patients don’t realize soon enough that they’re having a stroke. Second, about half of all stroke patients have atrial fibrillation (AFib), an irregular heart rhythm, and take anticoagulant drugs to treat the condition. These patients are not candidates for tPA. The drug also doesn’t work on larger clots.

The neurointerventional procedure typically begins with a tiny surgical incision made in the groin to access the femoral artery. In some cases, the surgeon may access the blood vessels through the wrist. A small, thin, flexible tube known as a catheter is then inserted and guided through the blood vessels until it reaches the clot.

Once the catheter is in place, depending on the type and location of the clot, in addition to other factors, the surgeon may insert a device similar to a tiny vacuum cleaner that sucks out the clot, or may use a tiny mesh stent to open up the blood vessel and pull out the clot.

“I can remove the clot very reliably, with a success rate of more than 90 percent,” Dr. Gaughen says. “The sooner we get patients here and treat them, the more likely they are to recover. That’s why the helipad and air ambulance service are so important.”

Around-the-Clock Intervention

Because stroke can occur at any time, Sentara Martha Jefferson’s neurointerventional surgery service is available to accept patients 24/7, every day of the year, whenever the need arises.

“We are pleased to have a neurointerventional surgery team available to provide care for any stroke patient who needs this particular treatment,” Lecker says. “When patients come to Sentara Martha Jefferson, they can be assured that they’ll be taken care of by a team of skilled clinicians who embody the hospital’s Caring Tradition. It’s very important to us not only to have excellent clinical outcomes, but also to make sure that patients and their family members feel cared for and embraced by our caregivers.”

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