Revolutionizing Stroke Care: 'Good is not good enough'
July 01, 2019
When the FDA approved tissue plasminogen activator (tPA) in 1996 for the treatment of stroke patients, those who received tPA within a short window of time often suffered no permanent damage or deficits.
But now CHI Health Interventional Neurologist Vishal Jani, MBBS, is offering an even bigger game changer.
A procedure called a mechanical thrombectomy is now proving even more successful (90 to 92 percent success rate compared to 3 to 6 percent for tPA in large artery clots) in minimizing deficits in the stroke patient.
Another big advantage to thrombectomies: doctors have a bigger window for using the new tool. TPA may be considered the “gold standard” but it must be given within four-and-a-half hours of symptoms appearing.
Dr. Jani not only is improving quality of life – he’s also saving lives – by performing thrombectomies.
He threads a catheter through an artery in the patient’s groin to the blocked artery in the brain. A specialized device called a stent retriever is placed through the catheter through the clot and in a few minutes, engulfs the clot. At that point, Dr. Jani removes the trapped clot. When he does, blood flow to the brain resumes immediately and brain cells are no longer deprived of oxygen.
Dr. Jani saves the patient from a “brain attack.”
With this technique and with the use of advanced imaging devices, he can treat stroke patients up to 24 hours after the first symptoms.
“We are using artificial intelligence software to help detect large strokes outside the time window,” Dr. Jani said. He is the only vascular neurologist in the state to perform the important emergency procedure.
“Good is not good enough when better is possible,” Dr. Jani said.
CHI Health Immanuel has earned a top national stroke certification for its work. They were the fourth in the country to receive Advanced Certification as a Thrombectomy Capable Stroke Center by the Joint Commission.
Overall outcomes for stroke cases at the Neurological Institute at CHI Health Immanuel are “extremely impressive,” Dr. Jani said. “If left untreated, stroke has a mortality rate of 80 to 90 percent, but now with the advent of sophisticated technology, more than 60 to 70 percent of the patients are independent and resume their lives just the way they deserve.”
And while the American Stroke Association recommends patients receive clot-busting therapy in an hour or less, the Institute’s goal is a door-to-needle time is 30 minutes or less.
Time and brain are being saved with the new FDA-approved thrombectomy device, Tele-Stroke technology and artificial intelligence which detects larger clots in less than a few minutes of a patient’s arrival at the ER. With these advances, Dr. Jani revolutionizing stroke care and giving patients more hope than ever before.
He currently serves as CHI Health System Stroke Medical Director for all 14 hospitals in Nebraska and southwest Iowa.
Stroke is feared because it can be so debilitating. It’s the fifth leading cause of death in the United States and the leading cause of disability. People who have strokes can be permanently paralyzed on one side of the body or lose their ability to speak and comprehend. It’s estimated more than two-thirds of survivors have some type of disability.