“Stroke is the fifth-leading cause of death in the U.S. and the leading cause of disability,” says Dr. Andrea DeLeo, interventional neurologist and medical director of the Stroke Center at St. Catherine Hospital in East Chicago.
That adds up to the roughly 140,000 Americans who stroke kills each year — accounting for one of every 20 deaths — according to the Centers for Disease Control and Prevention. Every year, more than 795,000 people in the United States have a stroke.
These numbers hit home harder in Indiana, part of the “stroke belt,” a group of 11 states where strokes are prevalent in at least 10 percent of the population. The other 10 states are Alabama, Arizona, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia.
But the numbers tell only part of the story. Six Community Healthcare System medical experts in neurology, cardiology and neuroendovascular surgery brought the issue into sharper focus at a recent symposium called "The Heart-Brain Connection."
“Cardiovascular disease is the leading cause of death, and the functions of the heart and the brain are interrelated,” DeLeo says.
DeLeo and Dr. Ender Akan, neurologist and medical director of the Stroke Center at Community Hospital in Munster, moderated the January program at the Center for the Visual and Performing Arts in Munster.
The biggest risk factors for stroke are atrial fibrillation, called Afib, and patent foramen ovale, PFO for short, DeLeo says, adding that more than 80 percent of strokes are preventable. Innovations in prevention and treatment have improved patient outcomes and quality of life.
Preventive technologies include the Watchman Implant and Lariat Suture Delivery Device, which can regulate the heart, Dr. William Spear, electrophysiologist at Community Hospital, told the estimated 200 people in attendance.
Spear says the risks of AFib include age, hypertension, family history, heart disease (valve problems), obesity, sleep apnea, and lung and thyroid disease. AFib also may be triggered by alcohol, caffeine, stimulants, decongestants, surgery, exercise, exhaustion and stress.
Signs of AFib include dizziness, fatigue, shortness of breath, chest pain, fainting, and chest palpitations or fluttering. The patient may not show any symptoms.
“If AFib is left untreated, it increases the risk of stroke by five times the normal risk and can cause heart failure,” Spear says.
“Blood clots due to AFib can travel to the brain and cause a stroke. It’s a direct heart-brain connection.”
Spear explained that the Watchman, inserted through a leg vein, prevents clots from forming. It replaces the blood-thinner warfarin (brand name Coumadin) in patients with AFib not caused by a heart valve issue.
The Lariat Suture Delivery Device does the same thing. A catheter is inserted to close off the left-atrial appendage with a suture and removed, leaving no device in the body.
“Every 45 seconds, someone in the U.S. has a stroke,” says Dr. Tareq Kass-Hout, an interventional neurologist at Community Hospital who discussed interventional stroke treatment.
“Time is brain,” Kass-Hout adds, a theme repeated throughout the symposium.
“Someone suffering a stroke must get immediate care — as time is of the essence to save that person. Two million neurons (cells) in your brain die each minute after a stroke. Without treatment, a person can lose four years’ worth of brain cells in one day.”
He talked about advances in removing blood clots in the brain. A stent inserted in the brain allows room for a catheter to suck out the clot.
Because strokes usually are detected when they’re happening, prevention is key.
“We are seeing more strokes because of more obesity and diabetes in the population and because, in general, everyone is living longer,” says Dr. Samer Abbas, interventional cardiologist and medical director of cardiovascular services at Community Hospital.
More advances in the offing
Abbas, repeating the "time is brain" concept, detailed advances on the horizon, including a robotic helmet placed on the patient in the ambulance that sends critical data to the hospital team so it can be ready when the patient arrives.
A special visor also can be used to detect swelling in the brain and allow for a network mobile CAT scan to be done while a patient is en route to the hospital. Using artificial intelligence, scan results are ready in just six minutes and sent to the waiting hospital team.
“For many years, we were eight to 10 years behind cardiology,” says Dr. Demetrius Lopes, neuroendovascular surgeon at Community Hospital. “Now we’ve caught up, and we are interacting with each other.”
They found, he says, that as instances of heart disease went down, occurrence of strokes increased.
“Working in collaboration with cardiologists was meant to be,” says Lopes, who treated former Chicago White Sox pitcher Danny Farquhar after he suffered a brain hemorrhage from a ruptured aneurysm in April 2018.
Such hemorrhages account for 15 to 20 percent of strokes. About 30 percent are fatal at the time of the rupture, and of patients who survive, almost half do not return to normal health. Farquhar, who recently signed a minor league contract with the New York Yankees, beat the odds.
Abbas says the High-Frequency Optical Coherence Tomography, HF-OCT Imaging, is the next generation of intravascular imaging under development for intracranial use.
“It’s a technology that was previously used in the heart,” he says.
“Now we can use it to see inside the blood vessels in the brain, including the wall and the layers of the blood vessels. We can place a device into the aneurysm to heal it.”
A 3-D printed model of the affected vessel allows physicians to “practice” before performing the surgery.
Lopes says these and other innovations foretell a new wave in stroke care, with patients taking charge.