Patient Dionne Garcia, shown at a follow-up visit six weeks after her stroke, with Johanna T. Fifi, MD, center, and Gal Yaniv, MD, PhD, a second-year neuroendovascular surgery fellow.
On Tuesday, May 1, Dionne Garcia, 72, who was in New York City from Peru visiting her daughter, began experiencing slurred speech and weakness on her left side, and was becoming increasingly unresponsive. EMS arrived at her daughter’s home in Astoria and immediately took her to Mount Sinai Queens, a primary stroke center. Her stroke severity was assessed at 22 on the National Institutes of Health Stroke Scale, indicating severe stroke. Within 15 minutes of her arrival at the hospital, her CT angiogram revealed a blockage of the right middle cerebral artery.
With stroke, each passing minute increases the likelihood of permanent brain damage, and urgent treatment was needed for Ms. Garcia. The Mount Sinai Queens Emergency Department contacted the Mount Sinai Comprehensive Stroke Center at The Mount Sinai Hospital. The Center’s Director, Stanley Tuhrim, MD, Professor and Vice Chair for Clinical Affairs in the Department of Neurology at the Icahn School of Medicine at Mount Sinai, immediately triaged the situation and identified the patient as having an emergent large vessel occlusion stroke (ELVO), one of the most devastating forms of stroke.
Dr. Tuhrim notified The Mount Sinai Hospital endovascular stroke team, led by Johanna T. Fifi, MD, Associate Professor of Neurosurgery, Neurology, and Radiology, and Associate Director of the Cerebrovascular Center for the Mount Sinai Health System. She, along with a neuroendovascular fellow and a radiologic technologist, quickly traveled to Mount Sinai Queens. There, they performed a minimally invasive endovascular thrombectomy to remove the blockage.
Doctors threaded a catheter through Ms. Garcia’s groin up to her brain, and used a combination of aspiration and stent-retriever techniques to completely open the blocked vessel. Within 24 hours of her procedure, Ms. Garcia showed no symptoms of stroke, and she was discharged to her daughter’s home less than a week later.
“Because of the recent advances in technology and the overwhelming evidence for thrombectomy, patients like Ms. Garcia are saved from a life of disability every day,” says Dr. Fifi, who is also Director of the Health System’s Endovascular Stroke Program.
In the past 12 months, the Mount Sinai Health System has performed nearly 200 endovascular thrombectomies, which are now considered the gold standard of stroke care for large-vessel occlusions detected within six hours of onset, and up to 24 hours for a subgroup of patients. The Mount Sinai Cerebrovascular Center has pioneered many of these endovascular techniques and approaches intended to speed up the assessment and treatment of stroke to eliminate or minimize brain damage.
To further address the time sensitivity, Mount Sinai created the innovative mobile interventional stroke team (MIST) approach, in which stroke specialists quickly travel—by taxi or subway—to the patient who has been brought to a Mount Sinai Health System primary stroke center.
The MIST strategy, which aims to minimize risks and the delays inherent in patient transfer, allows for parallel processing of patients who are prepared for the procedure, and in some cases are given the clot-busting drug tPA intravenously, simultaneously as the team is mobilized. In a study led by Dr. Fifi and published in the journal Stroke in December 2017, the MIST model of care had an onsetto-treatment time that was 79 minutes faster than transporting patients from a primary stroke center to a comprehensive stroke center for treatment.
Currently, The Mount Sinai Hospital, Mount Sinai West, and Mount Sinai Beth Israel are thrombectomy-capable. In October 2017, Mount Sinai Queens became the first center in the borough to provide thrombectomy procedures, and construction is ongoing to create, for early 2019, a fully thrombectomy-capable stroke center entirely designed to maximize speed and efficiency in diagnosing and treating all stroke.
J Mocco, MD, MS, Professor and Vice Chair of Neurosurgery, and Director of the Cerebrovascular Center at the Mount Sinai Health System; Dr. Fifi; and stroke team members also continue to advance innovative stroke treatments and technologies.
“The Mount Sinai stroke team has become an international leader in published research aimed at saving more stroke patients’ lives,” says Dr. Mocco. “We are addressing important questions and improving patient care at every stage of ELVO treatment, from initial evaluation, through acute treatment, to rehabilitation.” Among their efforts: they are testing an innovative device that may one day be used by 911 responders to detect and diagnose stroke and other brain disorders in the field; investigating artificial intelligence algorithms to speed up the detection and triage of stroke patients; and leading national trials investigating a number of other new devices for stroke.
“Only a few years ago, many major strokes were fatal, or patients were left with devastating effects. However, with rapidly developing technology and systems of care, Mount Sinai is changing the global conversation about stroke treatments,” says Joshua B. Bederson, MD, Professor and Chair of Neurosurgery at the Mount Sinai Health System. “While other hospitals in New York City focus on stroke diagnosis with ambulances that are outfitted with CT machines, our stroke-treatment team meets the incoming patient upon arrival at one of our Health System locations in Manhattan, Queens, and Brooklyn. Within minutes, the patient is diagnosed, and advanced endovascular treatment restores blood flow to the brain.”