Page 22 - Christiana Care Health System Focus September 2018
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Acute Medicine | Acutestroke CONTINUED
  The DAWN of a new era in stroke care
Neurointerventional specialists have had CT perfusion and imaging capabilities for years, but the core issue, said neurointer- ventional surgeon Thinesh Sivapatham, M.D., was figuring out what amount of brain tissue was permanently injured and what was salvageable. The old imaging tests sometimes offered good information, he said, but they were slow, labor-intensive and, most importantly, not reliable.
Aided by data from comprehensive stroke centers across the country (including Christiana Care), two recent landmark randomized controlled studies — the DAWN and DEFUSE 3 trials — present strong, clear benefits for patients who meet criteria for mechanical thrombectomy beyond the traditional six-hour treatment window thanks to RAPID CT perfusion.
DEFUSE 3 found that when patients are carefully selected using RAPID CT
“With RAPID, the information we need to make better- informed treatment decisions is on our phones in two or three minutes.” Thinesh Sivapatham, M.D.
perfusion, mechanical thrombectomy
is highly effective from six to 16 hours
after the patient was last seen normal. DAWN showed that use of RAPID widens the treatment window for mechanical thrombectomy to as many as 24 hours. Both are monumental news for patients who wake up with stroke symptoms that likely originated well beyond the traditional six-hour treatment guidelines.
“Before the DAWN and DEFUSE 3 trials, we did not have a fast, safe and reliable way
to choose patients for treatment,” he said. “Now we do.”
Within minutes of performing a RAPID CT Perfusion scan at Christiana Hospital, Jonathan M. Raser- Schramm, M.D., Ph.D., (left) stroke neurologist
and medical director of Christiana Care’s Stroke Program, and neurointerventional surgeon Thinesh Sivapatham, M.D., review the scan information
on a smart phone to begin deciding whether the patient may benefit from emergent mechanical thrombectomy.
The automated RAPID CT perfusion software is consistent, high quality and very fast — hence the name RAPID.
Said Dr. Sivapatham, “With RAPID, the information we need to make better- informed treatment decisions is on our phones in two or three minutes.”
Right care, right place, right time
Without cutting-edge imaging platforms like RAPID CT perfusion and therapies like IV alteplase or mechanical thrombectomy to stop a stroke in its course and restore blood flow to the brain, patients may be left bedridden. When blood flow is restored to viable brain tissue, patients often begin talking and moving limbs right on the treatment table in the interventional suite.
“To have such a drastic improvement in patients so quickly is what drives us to do the best we can and stay on top of current guidelines,” said Dr. Sivapatham.
Participation in national guideline-chang- ing trials such as DAWN — and staying on the cusp of cutting-edge changes in stroke care — are important responsibilities for Christiana Care. Christiana Hospital is one of only a select few in the country that the Joint Commission has designated a com- prehensive stroke center, where patients can receive the highest level of stroke care, including life-saving neurointerventional and neurosurgical procedures. Wilmington Hospital serves as a primary stroke center.
“As stroke care leaders in our community, we keep our fingers on the pulse of the latest technology, research and treatment options available, thereby giving our patients the best possible care,” said
Dr. Albani. “It is our job and our duty to be

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