UTSW’s Advanced Comprehensive Stroke Center certification raises bar in patient treatment, research

Ellie Raj and Mary Alice Stam
An alert friend, Ellie Raj (left), called 911 after realizing that her friend Mary Alice Stam was having a stroke. Mrs. Stam was treated with an innovative new procedure by physicians with UT Southwestern’s Robert D. Rogers Advanced Comprehensive Stroke Center.

Mary Alice Stam already was experiencing some classic stroke symptoms − slurred speech, dwindling vision, and inability to move her left side – by the time she arrived at UT Southwestern’s Robert D. Rogers Advanced Comprehensive Stroke Center one day in late 2014.

UT Southwestern neurointerventional surgeons quickly begin an innovative procedure called endovascular rescue therapy (ERT), inserting a catheter into Mrs. Stam’s femoral artery in the thigh, reaching up and into the middle cerebral artery of the brain where a clot was blocking blood flow. Extending a wire mesh stent into the artery, they pulled out the clot to restore blood flow.

“It was a great team effort,” said vascular neurologist Dr. Mark J. Alberts, Professor and Vice Chair of Clinical Affairs in the Department of Neurology and Neurotherapeutics at UT Southwestern. “The fast actions of her friends and family, and the Grapevine professionals in getting her here quickly, as well as the speed and efficiency of our team at Zale Lipshy University Hospital gave her the best chance of having a good recovery and resuming her active and fulfilling lifestyle.”

Today, Mrs. Stam, who with her husband sponsors and cares for a memorial to Vietnam War veterans at Sparger Park in Colleyville, is essentially neurologically normal and can do all of her typical activities.

“I’m sure glad to be here,” she said. “If there’s one thing I could tell people who face a stroke, it’s to take action and get examined by stroke experts.”

For Mrs. Stam, speed to treatment by UT Southwestern’s top stroke experts made all the difference. With ERT in particular, stroke patients may recover faster and avoid disability if the procedure is performed within the first six hours.

It all began when a friend noticed that Mrs. Stam’s speech was garbled and she could not extend the fingers of her left hand. She went to a Grapevine community hospital for assessment, then was referred to UT Southwestern via a stroke referral hotline. The hotline was established as part of a selective joint certification by The Joint Commission and American Heart Association/American Stroke Association as an Advanced Comprehensive Stroke Center, a distinction for hospitals fostering specialized stroke care and expertise for patients. UT Southwestern has the only AHA/ASA/Joint Commission-certified advanced comprehensive stroke center in North Texas.

Dr. Mark Alberts
Dr. Mark Alberts

“With stroke, time equals brain, said Dr. Alberts, who was integral in developing national criteria for primary and comprehensive stroke centers. “We call it the ‘Golden Three Hours.’ If we can get to the patient early in the stroke, we have a vastly improved chance of making a difference.”

UT Southwestern launched a coordinated cerebrovascular diseases program in 1999, which has matured into the Stroke and Cerebrovascular Diseases Section of the Department of Neurology and Neurotherapeutics, a multidisciplinary effort that brings together neurologists, neuroradiologists, and neurosurgeons with vascular, endovascular, critical-care, and rehabilitation expertise to treat all forms of stroke and blood-vessel diseases affecting the brain and spinal cord.

“We are fortunate to have the technology and expertise at UT Southwestern to do complex procedures that may be needed for our patients,” said Dr. Mark Johnson, Chief of this Section and a vascular neurologist who specializes in complex stroke cases. “In our clinic and hospitals, we have focused on stroke and other cerebrovascular diseases with advanced care coordinated by a team of specialists dedicated to providing the best available care and optimizing recovery for patients.”

Certification as an advanced comprehensive stroke center requires that a hospital provide ready access to the technology and medications that can limit damage during or after a stroke. Zale Lipshy University Hospital lies at the center of UT Southwestern’s stroke care, offering carotid and transcranial Doppler, computed tomography angiography, 3-D rotational angiography, high-field magnetic resonance imaging and magnetic resonance perfusion, and diagnostic and interventional cerebral angiography. The hospital also is home to UT Southwestern’s acute stroke unit, featuring all-private rooms and neurosurgical operative suites, as well as a 20-bed neurocritical care unit.

A 2010 study in the journal Stroke found that stroke centers following national guidelines recorded fewer fatalities and reduced institutional care a year later compared with general hospitals. They also had lower mortality rates during a nine-year follow-up; and increased median survival rates.

As an academic medical center, research is a critical component of the stroke program. Over the decades, UT Southwestern stroke specialists have pioneered development of some of the most advanced and effective brain aneurysm procedures in use today. Currently, UT Southwestern is participating in many cutting-edge studies to better treat stroke patients and prevent another stroke.

“We’re constantly striving to participate in the latest clinical trials that can help guide our treatments for the best possible outcomes,” said Dr. Johnson, also Professor of Neurology and Neurotherapeutics.

For example, UT Southwestern is one of just three national sites to pioneer U.S. testing of an implant device that stimulates the vagus nerve in stroke patients to help restore lost arm function. Stroke deprives brain cells of oxygen, causing them to die and be unable to perform normal functions. In early tests with the device, the brain appears to ‘rewire’ other cells to perform those functions.

“A top priority at UT Southwestern is ensuring that our programs and procedures deliver the best possible care to each patient on a consistent basis,” said Dr. John Warner, Vice President and Chief Executive Officer of UT Southwestern University Hospitals, Professor of Internal Medicine, and holder of the Jim and Norma Smith Distinguished Chair for Interventional Cardiology, and the Audre and Bernard Rapoport Chair in Cardiovascular Research. “Patients come to us because of our world-class expertise, not only in stroke care, but in every aspect of the care they receive at our hospitals.”