Neurovascular Specialists and Stroke Care – Johnston-Willis Hospital

I’m Dr. Spinos and I am a neurovascular
specialist I have been doing our nuerovascular procedures in the central
virginia area for over 30 years A neurovascular specialist or neuro
interventionist is a physician that specializes in the minimally invasive
management of stroke as well as other diseases of the nervous system. HCA’s
Capital Division which includes Henrico Doctors’ Hospitals as well as Chippenham
and Johnston Willis hospitals are committed to providing the very best in
stroke care in the Central Virginia area what Johnston Willis Hospital has to offer
that is different from other hospitals is that it is a comprehensive Stroke
Center it’s one of the few private hospitals that has the distinction of
attaining and maintaining the comprehensive Stroke Center status. Well
that entails that you have the immediate availability of a neurovascular
specialist such as myself as well as a neurosurgeon and a neurologist 24/7 that
you have availability of what’s called a neuroscience ICU that’s a special place
where patients are cared for in an intensive care setting. We also have a
neuro rehabilitation center as part of the stroke capabilities of this hospital
and that helps patients recover their faculties and improve their quality of
life. But when a patient arrives at the Johnston Willis emergency room door the
first thing that happens that they get what’s called a CAT scan and that tells
us whether that stroke is one that it’s a bleed or it’s a stroke that has
inadequate blood flow going to the brain if it’s an ischemic stroke that is
the inadequate blood flow going to the brain then they immediately get
evaluated for the delivery of what’s called thrombolytic medication which is
a clot-busting medicine that helps break up the blood clots. Strokes and the
management of stroke has changed considerably in the last few years in
addition to this thrombolytic medication or the clot-busting medicine we now have
something called a thrombectomy or neuro
thrombectomy where we actually can go into the brain and remove blood clots
that are blocking the circulation to the brain. The advantage of this new
technology is that it’s twofold it allows us to take care of patients that
have large strokes and it allows us to care of patients that have had a stroke
in some time in the prior 24 hours so our window for managing these patients
has now extended from four and a half hours which was the traditional window
all the way out to 24 hours. In addition to this new treatment method we also
have new technology that allows us to quickly evaluate patients and try to
determine who will best benefit from this new therapy. Rapid is an automated
stroke imaging tool that allows us to select patients that will do best when
revascularized. What you see in front of you is an image of the brain that has
undergone a stroke the purple that you see is tissue that is damaged and
possibly irrecoverably damaged the green which is a much larger area represents
areas of the brain that are recoverable and potentially can benefit from
revascularisation or reopening up of the blood vessels of the brain. On the left
you see a cat scan picture of a patient that has had a blockage to the left
middle cerebral artery or the artery that goes to the left side of the brain
and here on the right you see an angiogram of the same thing
demonstrating how there is no blood flow going to the left side of the brain
where the blue arrow is at. Now you see what has happened after we have removed
the blood clot from the brain and you now see normal blood vessels going to
the left side of the brain. Using this rapid technology we can best determine
which patients will benefit most from this new therapy. Using this new therapy
we can reverse the vast majority of symptoms of a stroke and often make the
patient nearly normal. When a patient presents with a hemorrhagic stroke
or bleeding within or around the brain then either myself a neurovascular
specialist or both a neurovascular specialist and a neurosurgeon get called
and we see the patient and evaluate them if it’s blood around the brain which is
often from what’s called subarachnoid hemorrhage that usually means that there
is a ruptured aneurysm that has caused the patient symptoms. Modern techniques
have allowed us to take care of most of these aneurysms using a procedure called
coiling. What you see on this particular slide is an intracranial aneurysm that’s
a basilar aneurism that goes to the back of the brain before we treat it
and you can see the blood vessel coming up and the big the big bulbous structure
at the very top where the arrow is is the aneurysm. You can see what happens
after we put coils into the aneurysm and of course the final picture demonstrates
that the aneurysm is now completely excluded from the circulation and is
therefore fixed. The frontiers of stroke management are advancing very quickly
and HCA and Johnston Willis Hospital especially are at the forefront of this
rapidly advancing field. As a comprehensive Stroke Center Johnston
Willis has a responsibility to remain a leader in stroke management in the
central Virginia area

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