In Morgantown and in Charleston,
WVU physicians are working to save lives.
Time is Not on Their Side
Too often, WVU Stroke Center physicians must diagnose and treat
stroke patients after a devastating attack.
by Bill Case
A stroke—some call it a "brain
attack"—occurs when a blood vessel bringing oxygen
and nutrients to the brain bursts or is clogged by a blood clot
or some other particle. When the brain doesn't get the needed
blood flow, because of a rupture or blockage, it is deprived
of oxygen. Thus, the brain's cells cannot properly function and
they die.
When brain cells die, the function of the body parts they control
is impaired. This may cause paralysis, speech problems, memory
and reasoning deficits, coma, and possibly death.
Even if a stroke is not fatal, the devastating effects often
are permanent, because brain cells that die cannot be replaced.
Every hour that passes between the onset of stroke symptoms and
the beginning of medical treatment increases the chance of permanent
damage to the brain.
"Time is brain cells," says WVU neurologist David Libell,
M.D. That's why WVU opened West Virginia's first stroke center
last summer: to offer the fastest possible and best care to stroke
patients throughout the state and region. The Stroke Center at
WVU Hospitals offers emergency treatments that may stop a stroke
while it is happening.
"We now have the ability in some cases to fix strokes, or
prevent brain damage before it occurs—if we see the patient
soon enough," says Dr. Libell, who specializes in stroke
and neuromuscular diseases.
Many West Virginians are at high risk for stroke because of obesity,
heart disease, smoking, or other factors. In past decades, physicians
have had little success in treating people who had serious strokes.
But new developments in diagnostic imaging, and in treatment,
mean that some stroke symptoms can be avoided—or even reversed.
The WVU Hospitals Stroke Center evaluates and treats patients
who are at risk for stroke or who have suffered a stroke. Stroke
prevention therapy includes the use of medication to reduce the
risk of blood clot formation. Surgery to remove fatty deposits
from the arteries is also used for stroke prevention. In
addition to medication and surgery, lifestyle changes that can
help reduce risk are recommended, such as diet and exercise.
Specialists from neurosurgery, neurology, radiology, vascular
surgery, and emergency medicine make up the Stroke Center team.
They work quickly, and in close coordination, to assess stroke
patients and determine if they are likely to benefit from either
the newest drug therapies, surgery, or interventional radiology.
"We now have an opportunity to intervene during a stroke,
and to have an impact on stroke patients that earlier generations
of physicians did not have," says Julian Bailes, M.D., a
neurosurgeon.
Other members of WVU's multi-disciplinary stroke team are Ann
Chinnis, M.D., interim chair of emergency medicine; Kumar Pillai,
M.D., a vascular surgeon; and Abdulkader Al-Azzaz, M.D., a neuroradiologist
who specializes in neuro-interventional and diagnostic radiology.
There are two main types of strokes. The most common, ischemic
strokes, are caused by blood clots that block arteries, restricting
blood flow to the brain. Blood clots usually form in arteries
throughout the body, particularly those damaged by atherosclerosis—the
artery-narrowing disease that also is a major factor in heart
attacks .
A new therapy that can break up a blood clot or minimize the
damage caused by a stroke that has already occurred is available
to some patients. The therapy consists of a drug called t-PA
(tissue plasminogen activator) that dissolves the clot. At WVU,
the stroke team can use multiple high-resolution imaging technologies
to find the clot and help the physician deliver the drug directly
to it, even deep inside the brain.
A less common, but more dangerous, type of stroke is the hemorrhagic
stroke, caused by a breakage or "blowout" of a blood
vessel in the brain. Brain hemorrhages can be caused by long-term
high blood pressure and enlarged blood vessels in the brain (cerebral
aneurysms) and have a much higher fatality rate than ischemic
strokes.
Surgery to repair ruptured vessels or aneurysms in order to minimize
damage is offered at WVU, including such innovative techniques
as filling an aneurysm with tiny wire coils to strengthen it
against rupture.
All of the new methods of assisting stroke patients are most
effective if a stoke is recognized early, and the patient comes
to the stroke center without delay. Because speed is of the essence,
one goal of the stroke team is to educate the public to recognize
and respond quickly to stroke symptoms.
Emergency stroke services can be obtained by calling 911 at the
first symptoms of stroke. The WVU Hospitals Stroke Center will
coordinate with regional emergency service providers to make
sure stroke treatment begins as soon as the ambulance arrives.
Minimizing Risk
At WVU's Charleston Division, Ali F. AbuRahma,
M.D.,
is perfecting a life-saving surgical procedure.
by Tony Cook
"Stroke is the third leading cause
of death among the general population in both the nation and
West Virginia, and it is the second most common cause of death
in women," says Ali F. AbuRahma, M.D., a professor of surgery
and chief of vascular surgery at the WVU Robert C. Byrd Health
Sciences Center in Charleston.
Good reason for Dr. AbuRahma to spend much of his time trying
to perfect a surgical procedure to prevent stroke.
The Palestinian physician who was trained in Egypt, New York,
and Arizona has devoted his career to vascular medicine: treating
diseases of the blood vessels. His latest research involves perfecting
the surgical procedure called carotid endarterectomy, which involves
removing a blockage from the carotid artery to prevent stroke.
The carotid artery, located in the neck, supplies blood to the
brain.
There is always a risk of stroke during the surgery. AbuRahma
and his associates have compared various methods for closing
the carotid artery after removing the blockage, which is made
of fatty deposits called plaque. Their goal, he says, is "to
minimize the risk of stroke during and after surgery."
The results of his research are far-reaching. Through publication
in books and professional journals, and presentations at workshops
around the world, his research is helping other surgeons improve
the outcomes of the procedure—and save the lives of more
patients.
But the best thing one can do to prevent stroke, he says, is
simple: "Stop smoking." The nicotine and carbon monoxide
in tobacco smoke increase the formation of the plaque in the
carotid artery that AbuRahma removes surgically from about 200
patients each year.
Some patients develop blockages in more than one location of
the artery. They must endure multiple high-risk surgeries to
remove them. And the young are not immune. AbuRahma's youngest
patient was a 33-year-old man who started smoking at age 15.
WVU honored AbuRahma in the spring of 2000 with the Benedum Distinguished
Scholar Award. Thirty years before, he had won the State Prize
of Egypt as the country's top medical graduate in 1970. He has
been a full-time WVU professor since 1978, and is also the director
of the vascular laboratory at Charleston Area Medical Center.
West Virginians are fortunate to call him one of their own.