Meeting every emergency in stroke care
Written by Shari Roan | Photographed by Kristin Anderson
Charles Demachy remembers the headache most of all. It was crushing and “weird,” he says. En route to Providence Little Company of Mary Medical Center Torrance, he recalls feeling like there was bleeding inside his head. There was.
Demachy had a ruptured brain aneurysm causing a subarachnoid hemorrhage, a life-threatening condition in which a blood vessel in the brain bursts. In the emergency department, he was met by a medical team well-trained in saving lives from such neurological emergencies as stroke and aneurysm. It was the start of a long, difficult experience, but Demachy was already on the road to recovery.
Providence Little Company of Mary Torrance is considered the destination hospital in the South Bay for neurological emergencies.
For nearly a decade, Providence Little Company of Mary has been certified as an Advanced Primary Stroke Center. The high standards set by the staff have earned the hospital The Joint Commission’s Gold Seal of Approval, and it is now the only hospital in the South Bay to carry the distinction of Comprehensive Stroke Certification by The Joint Commission. The hospital is also a recipient of the American Heart Association/American Stroke Association’s Gold Plus Achievement Award and was the first in Los Angeles County to receive an EMS designation as a Comprehensive Stroke Receiving Center.
“Between 15 and 20% of patients with a subarachnoid hemorrhage like his die before they even get to the hospital,” says Jason Tarpley, MD, PhD, director of the Stroke & Aneurysm Center; Vascular and Interventional Neurology, at Pacific Neuroscience Institute—an affiliate of Providence Little Company of Mary Medical Centers San Pedro and Torrance.
“Luckily, he got to us early and we made the diagnosis in the emergency department and treated him within an hour. The first priority is to fix the aneurysm as soon as you can do so safely. If it re-ruptures, or if you get a second rupture, the mortality rate is nearly 100%. So, you want to get it fixed as soon as you can.”
In Demachy’s case, care began when the Manhattan Beach paramedics brought him to the right hospital. The emergency room physician quickly ordered a “code stroke” and a protocol was set into motion. A brain scan showed Demachy had an aneurysm, and a multidisciplinary team converged that included Dr. Tarpley, neurosurgeon Jean- Philippe Langevin, MD, of Pacific Neuroscience Institute, and vascular neurologist Yih-Lin Nien, MD, to create a treatment plan.
“After Dr. Langevin and I reviewed the case, we decided together that minimally invasive endovascular coiling of Charles’s aneurysm was the best treatment, and on the night of his admission I performed the coiling procedure,” Dr. Tarpley says. The minimally invasive procedure involved making an incision in the thigh and threading a telescoping catheter through the artery of the leg into the arteries of the brain, guided by imaging and a special dye. A series of smaller and smaller catheters were deployed until Dr. Tarpley placed tiny platinum coils into the aneurysm to prompt a clot to form and stop the blood flow.
“It’s a minimally invasive option, which is usually the best way to go,” he says of the procedure. “The tiny catheter goes into the aneurysm. You fill it full of tiny platinum coils, which are like strands of platinum that ball up like a ball of yarn to plug the aneurysm. It’s a pretty amazing procedure.”
“Everything happened really fast,” says Demachy. “I remember Dr. Tarpley telling me, we have to stop the bleeding.”
The coiling procedure is among the newer options for treating hemorrhagic stroke that can be offered at centers like Providence Little Company of Mary due to its top-rated stroke program.
“These are complex patients which require a lot of skill and practice,” Dr. Tarpley says. “As a comprehensive stroke center, PLCMMC is the highest volume thrombectomy center in Los Angeles, so our staff have a lot of experience.”
The aneurysm was quickly secured, and then Demachy had a two-week fight in the hospital ahead of him, Tarpley says.
“The hemorrhage from aneurysm rupture causes a fascinating host of potential physiological problems that need to be handled in a multidisciplinary fashion at a comprehensive stroke center like ours,” Dr. Tarpley explains. “Charles’s subarachnoid hemorrhage caused buildup of fluid in the brain—which is common in his condition— that required Dr. Langevin to place a drain in his brain and required exquisite neurocritical care by Dr. Caganap.”
Demachy spent two weeks in the hospital’s specialized neurocritical care unit, and was attended to by Scott Caganap, MD, a neurointensivist at Providence Little Company of Mary Torrance.
“The other critical aspect of caring for subarachnoid hemorrhage patients is neurocritical care,” Dr. Tarpley says.
“Dr. Caganap monitors the patient every single day for any physiological changes so we can address issues quickly when the patient gets into trouble. Dr. Caganap managed to get Charles through fluid buildup on the brain and clots in the legs and lungs, which are all common complications of this disease process.”
He still battles occasional dizziness, but he is back to work at the Demachy family’s nursery. He can drive his car and enjoy walks on the beach with wife, Virginia.
“Subarachnoid hemorrhage can throw a lot of different punches at you,” Dr. Tarpley says. “But as a comprehensive stroke center with great neurology, neurointerventional surgery, neurocritical care and neurosurgery, we know what punches to expect and how to fight back.”
PUSHING FRONTIERS IN STROKE CARE
Providence Little Company of Mary’s Comprehensive Stroke Center is participating in groundbreaking stroke research. These clinical trials provide promising new treatments that can lead to better outcomes for stroke patients in our community.
“Dr. Tarpley is an MD, PhD, and is the lead investigator on all of our stroke trials,” says Catrice Nakamura, MSN, stroke and neuroscience program director. “It’s due to his leadership, expertise and passion that we can offer clinical trials for our patients. Our research program gives us an added clinical approach for our stroke patients and those at risk for stroke in the community.”
The Joint Commission requires the Stroke Center to undergo Institutional Review Board-approved research aimed at improving stroke care, Nakamura says. Providence currently has six clinical trials in various stages of development at Providence Little Company of Mary, including two that are actively enrolling patients. Patients must meet inclusion criteria.
- One study involves testing a procedure to surgically remove blood clots in patients with strokes that impact a large area of the brain and who are not, under current criteria, eligible for this powerful procedure.
- The second is comparing two different types of devices used during the stroke clot retrieval procedure.
The other trials include:
- A follow-up to the ESCAPE-NA1 clinical trial that was published in The Lancet medical journal in February. The study explored the safety and efficacy of the neuroprotectant drug nerinetide in patients experiencing stroke. Providence Little Company of Mary Torrance is the lead site for a Providence-wide trial called ESCAPE-NEXT that will further evaluate this medication.
- CREST 2, which is a trial studying the treatment of carotid artery disease with carotid stent or surgical endarterectomy compared with medicines for the primary prevention of stroke.