STATUS REPORT 2019/2020

STRO

KE

750 EAST ADAMS STREET I SYRACUSE, NYWWW.UPSTATE.EDU/STROKE

The COVID-19 pandemic has brought theworld to its knees. It seems like a distantpast, being able to gather and celebratewith people you love. We are at war withan enemy we cannot see. In addition tothe many lives lost, many more have hadto suffer because of transient loss ofaccess to critical health services duringthe surge of the pandemic, includingpatients suffering from stroke who chosenot to go to the hospital for fear of beinginfected by SARS-CoV-2 virus. In addition,we experienced significant challenges indelivering rapid treatment for stroke dueto the additional time needed to don thepersonal protective equipment (PPE)before interacting with the patient.Patients in the hospital were unable tosee their loved ones due to the visitationrestriction necessary to protect the sickand health care workers. In one instant, anew normal emerged, with the need forsocial distancing, the need for masks inpublic, and the need to limit the personalinteraction that human relationships andcommunication are built upon.

Upstate was at the forefront of thisunprecedented response to thepandemic. Some of our colleagues

volunteered to work in New York City andsurrounding regions to give a helpinghand. Very early on, we institutedchanges to allow continued acute careservices for stroke intervention, includingchanging our provider schedule so thatwe could increase our capacity in theevent of a surge, increased use oftelemedicine, and changing ouremergency protocol to incorporate PPEdonning and doffing, isolating suspectedand confirmed COVID-19 patients.

As the largest neuroscience team in theregion, I would like to assure ourcommunity that the UpstateComprehensive Stroke Center is and willremain ready and prepared to care for ourpatients, and to deliver the highestquality, the most consistent and safestemergency and acute care interventionin stroke. Despite significant challenges,we were able to maintain 100%treatment of Alteplase (IV tPA) to patientswithin 60 minutes from their arrival at theemergency room, with more than 75% ofthem within 45 minutes, and up to 50%within 30 minutes.

Our commitment to the region remainsthe same. We will strive to provide the

highest level of care for stroke, regardlessof whether you have COVID-19 or not.But we can only do this if you help us.Remember, think F-A-S-T* if you (or yourloved one) is having a stroke!

We are happy to share with you ouraccomplishments this past year and ourcurrent initiatives.

Sincerely,

Julius Gene Latorre, MD, MPHMedical Director,Upstate Comprehensive Stroke Program

* Think FAST!

F- does the FACE droop?

A- is one arm weak or numb?

S- Is speech slurred or hard to understand?

T- it's time to call 911, and ask for the experts,

ask for Upstate.

A MESSAGE FROMTHE MEDICALDIRECTOR

UPSTATE COMPREHENSIVE STROKE CENTER

Dear Central New York Community,

STROKE STATUS REPORT 1

TABLE OF CONTENTSStroke Care: Upstate Stroke Data. . . . . . . . . . . . . . . . . . . . . 2 - 3

Stroke Update from the Stroke Program Manager . . . . . . 4

Telestroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Stroke Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Patient Story: Nauseated and Dizzy . . . . . . . . . . . . . . . . . . . . 7

Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Patient Story: Teamwork Saves Lives. . . . . . . . . . . . . . . . . . . . 9

Patient Story: I Can’t Use My Arm. . . . . . . . . . . . . . . . . . . . . . 10

Training Tomorrow's Stroke Experts . . . . . . . . . . . . . . . . . . 11

New Views for the Diagnosis and Treatment of Stroke. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 - 13

Introducing the Newest Membersof Our Stroke Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 - 15

Patient Story: A Blinding Headache. . . . . . . . . . . . . . . . . . . 16

Community Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Stroke remains the leading cause of adult disability in the US.Upstate University Hospital is committed to reducing thatburden by expertly treating, caring for and educating ourregion on the complexities of stroke. Upstate began thispledge in 2006 as the first dedicated stroke center. In 2015,Upstate was the first to achieve Comprehensive Stroke CenterStatus, the highest level. Our hospital was also the first toestablish a dedicated Neuroscience ICU and have maintained itfor almost 50 years.

Our stroke center offers training for physicians, nursepractitioners and physician assistants in all areas ofneuroscience: neuro critical care, neurosurgery and stroke.

Our nurses are the most specialty certified in the region, withmany earning national certification in Neuroscience Nursingand/or Stroke Nursing.

As an academic medical center, we can offer our patientsclinical trials, which can help determine if a medication ortreatment is safe and effective. This allows Upstate to offer thelatest treatment options for our patients. Throughout this pastyear, we have continued to represent Upstate by presentingour research work and quality improvement projects at variousprofessional conferences including American Academy ofNeurology, Northeast Cerebrovascular Consortium andInternational Stroke Conference.

68 % Ischemic Stroke

14 % Intracerebral Hemorrhage

5 % Subarachnoid Hemorrhage

12 % Transient Ischemic Attack

Types of Strokes Treated in 2019

2 UPSTATE COMPREHENSIVE STROKE CENTER

We do it with Purpose. Each minute that ticks by from themoment the patient enters ourdoors is vital to saving brain cells andrestoring the patient’s ability duringan acute stroke event. The AmericanHeart/Stroke Association haveshortened the expected treatmenttimes for award levels in 2019pushing stroke centers to movefaster and faster. Upstate hasresponded to this expectationquickly with almost half of ourpatients treated with Alteplase (IVtPA) last year receiving it in 30minutes or less. Correspondingly, ourmedian door to Alteplase (IV tPA)treatment time has remainedconsistently at or under 36 minutesfor the last consecutive four years.

We value Performance. Upstate continues to earn thehighest Gold Plus award level whichrecognizes performance of 24consecutive months of all the StrokeMeasures for excellence in StrokeCare ( i.e. early anti-thrombotics,statins at discharge, anticoagulation,patient education, VTE prophylaxis.).

We are Prepared. Our Upstate Stroke Program hasseen a consistent increase in patientvolume over the last five years. Weare prepared to take care of all typesof stroke from those with earlywarning signs to the most complex.In the last year, we have stepped upto the challenge of an increase in thenumber of patients needingspecialized care for hemorrhagic orbleeding strokes. This care includescutting-edge surgical proceduresand comprehensive medicalmanagement.

Total Patients through the Upstate Comprehensive Stroke Center

2015 2016 2017 2018 2019

1408 1489 16501840 1917

Patients Diagnosed with Stroke

2015 2016 2017 2018 2019

819851

908

969 972

STROKE CARE

Stroke Treatments

2016 2017 2018 2019

Thrombectomy

Alteplase (IV tPA)

36

72

9586

84 89106 108

STATUS REPORT 3

STROKE UPDATE:FROM THE STROKE PROGRAM MANAGERJOSH ONYAN, BSN, RN, SCRN

Stroke care over the past twelve months was not initiallysupposed to have any big changes in practice. Alteplase (clot-busting medication) and mechanical endovascular reperfusion(thrombectomy) remained the approved treatment methods forsomeone having an acute stroke. As the COVID-19 pandemicbegan the volumes of stroke patients seeking care decreased.People with “less severe” strokes were remaining home out offear of contracting the virus by going to the hospital. We atUpstate had to assure our community that we had modified ourprocesses in order to safely care for stroke patients andremained a resource for our region.

In 2019, Upstate provided 108 doses of Alteplase. The UpstateStroke Program also provided care for almost 100 “drip and ship”patients. These are patients initially evaluated for ischemic strokeat one of our regional hospitals, given Alteplase there and thentransported to Upstate for more advanced imaging andneurological services. This method is done because the overallgoal of administering Alteplase is to do it as quickly as possible,with a target set forth by the American Heart/Stroke Associationof administration in less than 30 minutes of hospital arrival. Lastyear in the Upstate Emergency Department, the medianAlteplase treatment time was 34 minutes. Over 90% of ourAlteplase patients received their dose in under 45 minutes, andover 40 % of them received their dose in under 30 minutes. Thisis a great accomplishment which allowsUpstate Comprehensive Stroke Center toreceive treatment recognition through theAmerican Heart/Stroke Association.

In addition to the use of Alteplase for stroke,a mechanical endovascular reperfusionprocedure (thrombolysis-clot retrieval)remains the preferred treatment method forLVO (large vessel occlusion) stroke if notedon CT angiography. Upstate treated 86patients last year using this method. Of thesepatients, over half of them came from a regional hospital foradvanced comprehensive stroke care.

4 UPSTATE COMPREHENSIVE STROKE CENTER

Telestroke Partner Hospitals1 Canton-Potsdam Hospital

2 Carthage Area Hospital

3 Claxton-Hepburn Medical Center

4 Clifton-Fine Hospital

5 Cortland Regional Medical Center

6 Gouverneur Hospital

7 Lewis County General Hospital

8 River Hospital

9 Rome Memorial Hospital

10 Samaritan Medical Center

11 Upstate Community Hospital

10

8

24

3

5

7

11 9

6

1

STATUS REPORT 5

Through the use of technology and collaboration, theUpstate Telestroke network has expanded to include 11regional hospitals. The majority of the partneringhospitals are geographically located at least 60 minutesaway. Through the use of videoconferencing equipment,Upstate’s board certified stroke physicians are grantedinstant access to the patients and providers at ourregional hospitals. Using interactive computer software,and a secure internet network, CT images can betransferred and viewed in real-time. This allows theUpstate stroke providers to virtually assess the remotepatient and formulate a collaborative treatment plan.

Regional collaboration remains possible through severalquality committees led by the Upstate ComprehensiveStroke Center. The Regional Stroke Advisory Council(RSTAC) consists of representatives from EMS andhospital personnel through our five-county region. Ourmeetings allow an open forum to discuss regionalbarriers as well as regional successes. It takes a village toproperly care for these stroke patients and through theRSTAC, we all ensure that each patient, despitegeographical location, has the best access to the UpstateStroke Team.

Upstate has remained safe and strong for ourcommunity. We look forward to continued collaborationto enhance stroke care as a region.

Thank you all for remaining strong with us, for thepatients that we serve!

Members of the Upstate Telestroke Team includeTop, L-R: Karen Albright, DO, PhD, MPH; Julius Gene Latorre,

MD, MPH, Medical Director of Neurology-Stroke Service;

Hesham Masoud, MD

Bottom, L-R: Fadar Otite, MD, MS, Elena Schmidt, MD

Certified by international accreditors, DNV Healthcare, Inc., ourUpstate Comprehensive Stroke Center has the provenresources, infrastructure, processes and highly trained staff inplace to provide the very best in stroke care, including:

• Multidisciplinary team approach covering all the patient’sneeds including neurologists, neurosurgeons, interventionalradiologists, nurses, pharmacists, rehabilitation therapists,discharge planners, nutritionists, and social workers

• Region’s largest Neuroscience Critical Care ICU with teamscommitted to diagnosing and treating the most complexrequirements of all types of stroke and other neurologicalillnesses as well as dedicated neuroscience beds for non-ICUpatients

• Specialized Neuroscience Nursing staff with many nationallyCertified Registered Nurses earning certificationsin Neuroscience Nursing (CNRN), Critical CareNursing (CCRN), Stroke Nursing (SCRN) andNeurovascular Board Certification (NVRN-BC)

• Advanced imaging capabilities with the latestcomputed tomography (CT) and magneticresonance imaging (MRI) scanners which allowphysicians to make quick treatment decisionsextending the window for some patients up to24 hours since last seen normal or well

• Frequent use of Alteplase (clot-bustingmedication) for ischemic stroke treatment

• Activation of a specialized Neurovascular Teamto perform Thrombectomy (clot retrieval)procedures for qualified patients

• Neurosurgery or Endovascular specialists who perform stateof the art procedures for repair of aneurysms and othercauses of hemorrhagic strokes (brain bleeds)

• Telestroke/Telemedicine capabilities with virtual links to 11regional hospital Emergency Departments to assist localclinicians with stroke treatment decisions

• Participation in multiple clinical research trials improve andadvance stroke care

• Post-discharge care including a specialized Stroke Clinic withadvance practice nurses and neurologists who focus onteaching patients and families about reducing stroke risk andlinking patients to needed community therapies andresources

COMPREHENSIVE CARE

Median treatment time in minutes

2014

2015

2016

2017

2018

2019

48

41

34

34

36

36

DESIGNATED STROKE CENTER

6 UPSTATE COMPREHENSIVE STROKE CENTER

STATUS REPORT 7

NAUSEATED AND DIZZY AT 4 A.M. Debra Born, 25, had a stroke in the

middle of the night. Her difficulty

speaking helped her father realize he

needed to call 911.

PATIENT STORY

The patientDebra Born, 25, is a new graduate ofUtica College with a public relationsdegree. She lives north of Rome.

SymptomsBorn awakened feeling off about 4 a.m.on Aug. 6, 2019. She was nauseous andextremely dizzy. “I thought I was justexhausted and figured that was why Icould not move. I kept trying to saythat I was fine, but I had a hard timetalking.”

Her father, Frank Born, says it’s fortunateshe couldn’t speak. “She was trying totell us, ‘I’m OK. Just let me sleep.’ And wemight have.”

Instead, he dialed 911.

CareAn ambulance brought Debra Born tothe hospital closest to her home, RomeMemorial Hospital. The physician in theemergency department, via ateleconference with stroke specialists at

Upstate, arranged for a helicopter to flyBorn to Upstate University Hospital inSyracuse.

She had a blood clot in her brain thatwas swiftly removed by HeshamMasoud, MD, an interventionalneurologist with specialization invascular neurology and endovascularsurgical neuroradiology. Eighty percentof strokes are caused by clots, when anartery that feeds the brain becomesblocked. The other main type of strokehappens when a vessel bursts andbleeds. The treatment options aredifferent for each type of stroke, andcare is tailored to each patient basedon the size and location of the clot orbleed, and the patient’s condition andmedical history.

CauseMasoud explains that Born’s strokedeveloped from an arterial dissection, asmall tear in the lining of an artery atthe base of her neck. This likelyhappened when the artery rubbed

against her vertebrae, perhaps whenshe lifted something heavy or twistedin a certain way during physical activity.A clot developed, which caused anischemic stroke when it obstructedblood flow to the brain.

RecoveryThe clot retrieval is performed in anoperating suite, using micro catheters(tubes) and X-ray guidance. Born wasfeeling back to normal within hours ofthe procedure. When Masoud came toher bedside, she remembers, “he wasthrilled to see how well I was doing.”

She was hospitalized overnight andable to go home the next day, with nolingering deficits from her stroke. Bornsays she appreciates the prayers ofloved ones. “The skill of Dr. Masoud andmy whole stroke team was impressive,and I am grateful to them for doingtheir best to ensure that I walked awayalive and well.”

8 UPSTATE COMPREHENSIVE STROKE CENTER

The Upstate Regional Rehabilitation Centers offerindividuals who have experienced stroke cutting edgecare and best practice delivered by exceptionallytrained and dedicated professionals.

The Regional Rehabilitation Center staff provide carethrough a team process across the continuum of carewithin Upstate University and Community Hospitals.Members of the team consist of staff specializing instroke care, including physicians, nurses, physicaltherapists, occupational therapists, speech andlanguage pathologists. , psychologists and counselors,social workers, and case managers.

The staff demonstrate their commitment toindividuals with stroke through participation in theCenter’s stroke specific departmental training andpursuing specialty training which in some casesincludes the Certified Stroke Rehabilitation Specialistcredential. Nearly 50 of our team have completedtraining as Certified Brain Injury Specialists andNeurologic Certified Specialist. Three of our PhysicalMedicine & Rehabilitation physicians are certified inthe subspecialty of Brain Injury Medicine, with aphysician dedicated to outpatient and longer termcare needs.

Comprehensive Stroke care takes place in the Acutecare hospital , the Inpatient Rehabilitation Facility (IRF)and across Outpatient locations located in manyconvenient and accessible locations. Our qualityservices surpass others located in our region.

Indicator URRC Region (2N & 4E combined) (IRFs* in Eastern US)

Case Mix Index (Acuity) 1.68 1.59

Discharge to Community 69 % 66 %

Self-Care scoring Gain Ratio 1.18 0.94

Mobility scoring Gain Ratio 1.11 0.99

Self-Care Discharge: Patients that met the Target 67 % 48 %

Mobility Discharge: Patients that met the Target 57 % 49 %

Functional Efficiency 63 % 53 %

Upstate Regional Rehabilitation Center (URRC) Quality DashboardJune 2019 thru June 2020

(Higher Scores are Better Scores)

* Inpatient Rehabilitation Facilities

REHABILITATION

STATUS REPORT 9

TEAMWORK SAVES LIVES

A delivery of hosta plants and the fastaction of friends likely saved David“Chuck” Olley’s life. On June 11 in NaturalBridge, NY, Olley, 63, was home alonedoing paperwork when Carol Carrdelivered pots of hostas to sell at hisgreenhouse, which is adjacent to hishouse. Jamie Faury, a helper, was in thegreenhouse watering plants. She greetedCarr and called for Olley.

The three were walking through thegreenhouse when Olley said he neededto lie down. That worried his friends. Then,he fumbled and slurred his words. Carrand Faury recognized Olley’s garbledspeech as one of the “FAST” strokewarning signs (Face, Arm, Speech, Time).Deflecting his friends’ concern, Olleystruggled to say, “It’s not like I’m dying,”when the left side of his face drooped.Faury and Carr knew to call 911, despitehis protests.

The 911 dispatcher did a strokeassessment over the phone with Faury:“Ask him to smile.” Olley couldn’t. “Ask himto lift his left arm.” Olley couldn’t.

A day earlier, Olley had gotten resultsfrom a brain scan that showed he hadcarotid artery occlusions. This meant thatthe two arteries in his neck were cloggedby plaque, which restricted the bloodflow and oxygen to his brain. It is a

condition that often has no symptomsand can cause strokes.

Several minutes after the 911 call, a firstresponder from Natural Bridge arrived toevaluate Olley for stroke. The CarthageArea Rescue Squad got there approximately15 minutes after the 911 call. Speed wascrucial. Damage to Olley’s brain could beminimized if he could get to a strokecenter quickly.

The ambulance crew raced Olley to theCarthage Fire Department where theymet a Mercy Flight helicopter. In sixminutes, Olley was reevaluated, movedfrom ambulance to helicopter, andenroute to the Upstate ComprehensiveStroke Center in Syracuse. In 39 minutes,pilot Joe Carr landed the helicopter onthe roof of Upstate University Hospital.

The Upstate stroke team was waiting onthe helipad. They evaluated Olley whilethe helicopter was still running, savingfive minutes. He was taken immediatelyfor a CT scan, and Mercy Flightparamedics Brian Crolius and ConnorMiller gave a full report to the team,which included neurologist Gene Latorre,MD, MPH, and William Santiago, MD, ofemergency medicine.

The CT scan confirmed an ischemicstroke, a common type caused by a bloodclot which blocks blood flow to the brain.

The plaque in Olley’s neck vessels causedthe clot. Because he got to Upstate withinthree hours of the onset of the stroke,Olley was able to receive Alteplase (IV tPA)that dissolves blood clots. To remove theclot, interventional radiologist, Dr.Swarnkar performed a thrombectomy. Heinserted a tiny tube into the base ofOlley’s skull and threaded it through theblood vessels to the site of the clot. Then,he guided a metal thread with a basket-shaped clamp through the tube, and wasable to grab and remove the blood clot.

Olley was in the intensive care unit fortwo days. Three days after the stroke, heleft the hospital just in time to attend hisnephew’s wedding in Carthage,.

A couple of weeks after the stroke Olleywas back at work in his greenhouse andat several farmers’ markets. (On Saturdaymornings, he can be found at theHarrisville, market.) Six weeks after thestroke, Olley finds that he tires easily andhas some difficulty multiplying numbersin his head. Other than that, he is thesame robust man he was before thestroke. Carol and Jamie, his lifesavingfriends, keep a close eye on Olley whilethey sell homemade fudge andhandmade jewelry at the market.

Stroke survivor David “Chuck” Olley at the Harrisville

Farmers’ Market with Jamie Faury and Carol Carr. Their

decision to call 911 likely saved Olley’s life.

PATIENT STORY

10 UPSTATE COMPREHENSIVE STROKE CENTER

‘I CAN’T USE MY ARM’The patientLeonard “Larry” Johnson, 67, ofSyracuse, is a retired truck driver andconstruction worker.

SymptomsHe wasn’t feeling good the whole week.That Friday, Nov. 8, 2019, watching ESPNon television, Johnson hit the bed withhis right arm. His fiancée, Karla Rosen,thought he was excited about whatevergame he was watching. Then he tappedher. That got her attention. “I can’t usemy arm, I can’t use my arm,” hemuttered. “I feel funny.”

Rosen remembers Johnson’s lips weren’tworking right, his words were slurred,and his left side was weakened.

She called 911.

Because Johnson has congestive heartfailure, the couple is used to making

trips to the hospital emergencydepartment. “The doctor asked me, ‘Howdid you know to act so quickly?’ He saidthat’s what saved his life, why he wasable to bounce back so quickly,” Rosensays. “I thought this had something todo with his heart. I didn’t think of strokeuntil we got to the hospital.”

CareJohnson underwent a computedtomography scan that revealed a clot onthe right side of his brain. NeurologistHesham Masoud, MD, ordered athrombolytic medication called tissueplasminogen activator, or tPA, whichdissolves clots when administered in theearly stages of a stroke.

CauseA person with congestive heart failurehas an increased risk of stroke. Becausethe heart does not pump with optimal

force when it’s in congestive heartfailure, blood may stagnate in one of thechambers of the heart. This can createcircumstances for a clot to form, whichmay eventually travel to the brain andcause a stroke, Masoud explains.

In addition, people with heart failure canalso have an irregular heart rhythmcalled atrial fibrillation that increases therisk for stroke.

RecoveryJohnson went home after three days atUpstate University Hospital. Rosen sayshe’s not 100 percent back to himself, yet.“He’s got to go to physical therapy,” shesays. “We were really blessed that he wasable to bounce back.”

Stroke survivor Leonard “Larry” Johnson, 67, lost the

use of his arm as he experienced a stroke.

PATIENT STORY

Clinical TrainingIn addition to the only Simulation center of itskind in central NY, Upstate Medical Centerphysician trainees also work closely withdedicated faculty, utilizing cutting-edgetechnology in the diagnosis and treatment of cerebrovascular disease, to teach residentsthe care of stroke patients within a patient-centric care model. Our adult Neurologyresidency and Vascular Neurology fellowshiptraining programs offer young doctors intraining unique educational opportunities togain expertise in the delivery of stroke therapy.

As of 2019 Upstate has been proud to offer a training pathway tailored for Neurologyresidents and fellows interested in pursuing a career in Vascular Neurology and StrokeNeurointervention. This pathway establishes aclear route for Neurology physicians to obtainexpertise in the comprehensive care of strokepatients, to include the delivery of bothmedical (IV thrombolysis, secondaryprevention, diagnosis and prevention,neurorehabilitation) and endovasculartherapies of acute ischemic stroke (e.gintraarterial thrombolysis/spasmolysis,angioplasty and stenting, mechanicalthrombectomy).

Early Specialization in StrokeNeurointervention/Interventional Stroke Pathway (ESNI) After completing medical school, students willperform a residency in their chosen field. OurNeurology residency program pathway isstructured to provide additional subspecialtytraining in all aspects of Stroke managementincluding the delivery of intravenous

thrombolytics and the endovascular treatmentof ischemic cerebrovascular disease. Throughdedicated rotations managing patients on theinpatient Stroke and NeuroICU services, whilealso covering the Neuroangiography suite,residents gain the necessary clinicalexperience and training in all technical aspectsnecessary for proficiency in diagnostic cerebralangiography and endovascular treatment ofstroke, including complex procedures such asuse stent retriever device.

Accredited Vascular NeurologyFellowship with additionalStroke Neurointervention trainingOur post residency combined 2-year VascularNeurology and Stroke Neurointerventionfellowship training program expands on directpatient care with diagnosis and treatment ofstroke and emergent endovascular therapies.Fellows serve as Clinical Instructors (in the Sr. yr),with opportunities to practice as attending onthe Stroke and Telestroke service lines. Thecombined program allows clinical fellows in theACGME accredited (Accreditation Council forGraduate Medical Education) Vascular Neurologyprogram to extend training with a non-ACGMEyear and gain additional experience forproficiency in diagnostic cerebral angiographyand interventional stroke procedures.

A fellow is a board-eligible physician who hascompleted their residency and elects tocomplete further training in a specialty. Trainingin a fellowship is optional and is generally not arequirement to practice medicine, but is anecessary training for credentialing insubspecialties such as Vascular Neurology.

TRAINING TOMORROW'S STROKE EXPERTSUpstate Stroke Neurologists review

cerebral angiogram results showing

them the various blood vessels and

circulation pathways in the brain. A

stent retriever device shown in this

insert picture is an example of a device

used in some thrombectomy or "clot

retrieval" procedures to remove the

thrombus in the brain.

Carlos Y. Lopez, MD and Richard

Monroe, MD are current fellows

in the ACGME accredited

Vascular Neurology program.

Aaravind Reddy, MD and Neil

Suryadevara, MD, MPH are

current adult Neurology

residents in the ESNI training

pathway. Neil also serves as co-

chief resident and will continue

into combined fellowship

training in Vascular Neurology

and Stroke Neurointervention

next year.

STATUS REPORT 11

12 UPSTATE COMPREHENSIVE STROKE CENTER

The Upstate Department of Radiologyrecently made two large investments in bothCT and MRI equipment to improve the qualityand speed of a comprehensive diagnosis ofstroke for our patients. The UpstateComprehensive Stroke Team is grateful tohave radiology as an important member ofthe multidisciplinary team.

“In stroke care we use the CT and MRIscanners,” according to Daniel Gwilt, AssistantDirector of Radiology. “CT is used for a quickdiagnosis out of the ER when a patient firstarrives, while the MRI provides a moredetailed picture of the brain to see small areasof stroke and mapping to see flow of blood,vessels and tissues.”

NEW VIEWSFOR THE DIAGNOSIS AND TREATMENT OF STROKE

GE Revolution CT

Upstate University Hospital is the first facility in the

region to invest in this type of CT scanner. “With a 16

cm detector it allows us to capture a higher quality

image of the whole brain in one revolution,” Gwilt

said. This means the patient is in and out faster and

the team has a larger area of coverage with a higher

resolution image to be able to see smaller areas of

stroke across the entire brain.

CT Technologist and Stroke team member Chrissy

Shaw, RT (T), CT works quickly to correctly position

and explain to the patient the procedure in our new

GE scanner. Shaw has greater than 20 years of

experience with CT technology at Upstate.

Enhanced CT perfusion imaging allows for quick treatment decision-making for stroke

patients. The above image is a CT fusion image processed through the iSchemaView

product RAPID-AI. This software is utilized for all suspected stroke patients at Upstate.

Siemens Magnetom Vida

“This 3 tesla MRI scanner has a higher

image resolution than we had

previously,” Gwilt said. In addition,

this machine has dedicated

advanced neuro software, specifically

for the diagnosis and study of strokes

and other brain conditions.

MRI is often used to make a final diagnosis of stroke and to be able

to view deep brain structures. Brian Stewart, MRI technologist with

20 years experience is Board Certified in MRI and is a valuable

resource for Upstate and our Stroke team.

STATUS REPORT 13

14 UPSTATE COMPREHENSIVE STROKE CENTER

INTRODUCING THE NEWEST MEMBERSOF OUR STROKE TEAM

Harish Babu, MD/PhDAssistant Professor of NeurosurgeryDirector, Minimally Invasive Neurosurgery

Dr. Babu brings experience in brain tumor neurosurgery along with skill and expertise for patients who have epilepsy.

He is fellowship trained in twoneurosurgical sub-specialties and hasauthored several peer-reviewedpublications, manuscripts and bookchapters. He also is the recipient of manyawards and grants.

Dr. Babu is a summa cum laude graduateof Charité Medical University, Berlin,Germany where he earned his MD andPhD. He completed a residency at Cedars-Sinai Medical Center in Los Angeles. Hisfellowship in minimally invasiveneurosurgery was completed in Sydney,Australia, followed by a fellowship inepilepsy/functional neurosurgery at theUniversity of Toronto. His clinical researchand training were done at Charité MedicalUniversity, Stanford University and Cedars-Sinai Medical Center.

The Upstate Brain & Spine Center provide themost progressive and comprehensiveneurosurgical services in Central New York.

Our team of neurosurgeons combinesprofessional expertise with advancedtechnology, offering a multidisciplinaryapproach and compassionate care.

STATUS REPORT 15

Raisa Zhovklaya, BSN, RNUpstate Stroke Program Outreach Coordinator

Raisa Zhovklaya, BSN, RN has been named the newUpstate Stroke Program Outreach Coordinator. Ms.Zhovklaya brings a strong nursing background in strokeand neurosciences patient care, which began at Upstate.Along with her previous experience, Raisa was able toexpand her stroke knowledge by volunteering at a localEMS agency and her most recent clinical role in theNeuro-IR Department at the Neuro-IR department at alocal Comprehensive Center.

As the Comprehensive Stroke Program has grownexponentially since her career began at Upstate, she'sexcited to return to build strong relationships withpartnering agencies and continue to work collaborativelywith our the team to improve patient outcomes.

Timothy Beutler, MDAssistant Professor ofNeurosurgery Director, Critical CareNeurosurgery

Dr. Beutler is the firstneurosurgeon dedicated tocritical care neurosurgeryat Upstate and is director

of the program. The important addition of thisfield helps patients who need intensive carefor neurological emergencies such as brainand spine injuries, strokes, brain hemorrhages,infections of the brain and spine, andaneurysms. In addition, Dr. Beutler willperform general neurosurgery.

His primary clinical interests are in traumaticbrain injury and neuro critical care. Secondaryinterests include neurological qualityimprovement. He has authored numerouspapers, book chapters and abstracts.

Dr. Beutler received his MD from Case WesternUniversity. He completed a neurologicalsurgery residency and a fellowship in neurocritical care at Upstate Medical University.

Ali Hazama, MDAssistant Professor of NeurosurgeryDirector, Minimally Invasive Spine Surgery

Dr. Hazama, director of neurosurgery at theUpstate Community Hospital location of theUpstate Brain and Spine Center, has aspecialty focus on minimally invasive spinesurgery. One of the few surgeons in the regionwho can perform these spine surgeries, hisminimally invasive approach offers potentialtreatment options to correct common spineproblems.

He has taken leadership roles at Upstate onthe admissions committee and as chiefresident of neurosurgery. A winner of severalawards who demonstrates compassion intreating patients, he is also the author ofnumerous publications, book chapters andabstracts.

Dr. Hazama received his MD degree from theUniversity of Chicago Medical School and didhis residency in neurosurgery at UpstateMedical University.

16 UPSTATE COMPREHENSIVE STROKE CENTER

The patientSuzanne Sachetti, 65, of Watertown isretired as an information technologydirector.

SymptomsThe Sachettis have a lawn tractor. MarkSachetti remembers that on May 19,2019, his wife came into the garagesaying she was going to mow. She wentinto the house to use the bathroom first.Twenty minutes later, she still had notreturned. He went inside to check on her.Suzanne Sachetti told her husband shehad developed a blinding headache,become dizzy and started feeling strange— and now she saw two of him.

“Around that time, there were a lot ofstroke commercials on TV,” Mark Sachettirecalls. He recognized the signs of apossible stroke, and he knew what to do.His wife just wanted to rest.

He insisted they get to a hospital. Shehad trouble walking, but he helped herto the car. They drove to nearbySamaritan Medical Center. “I think she

could be having a stroke,” he said as theyentered the emergency department.

CareAfter a computed tomography (CT) scan,Sachetti was put in a room with atelemedicine connection to the UpstateComprehensive Stroke Center.Neurologist Karen Albright, DO, PhD,appeared on the screen. “Dr. Albrighttook control,” recalls Mark Sachetti. Tohim, his wife looked fine. Albright wasnot convinced.

After examining Suzanne Sachetti,looking at the scans and talking with theemergency doctor, Albright told theSachettis she believed Suzanne Sachettiwas having an ischemic stroke, caused bya clot. She told them about tissueplasminogen activator, or tPA, a clot-busting medication that can be effectiveif given early in the course of a stroke. Itcan also cause bleeding. That was a riskthe Sachettis were willing to take.

Soon after she received the medication,Sachetti was transported by ambulance

to Upstate. She stayed in a room in theneurological intensive care unit. “All ofthose nurses and all of those doctors,they treated her very well, and they knewwhat they were doing,” Mark Sachettirecalls. He brought his wife home threedays later.

CauseBoth of Sachetti’s vertebral arteries — themajor arteries in her neck — wereblocked. Some plaque broke off in one ofthem and traveled through thebloodstream until it blocked an artery inthe cerebellum. That is the section of thebrain that controls speech and balance.Strokes in this area can be devastating.Mark Sachetti says he realizes connectingwith Albright so quickly for treatmentmade a big difference in his wife’srecovery.

RecoverySachetti has some cognitive and short-term memory issues, her husband says,but physical therapy has helped improveher dizziness and balance.

A BLINDING HEADACHE

Upstate neurologist Karen

Albright, DO, PhD,

evaluated Suzanne

Sachetti long distance.

PATIENT STORY

STATUS REPORT 17

Our 2019 events season was busy! Whilewe may need to stay apart for now, welook forward to returning to theseoutreach events soon.

Strike Out Stroke to kick offStroke MonthOur tenth annual Strike out Strokebowling event to benefit the UpstateStroke Fund raises funds for patient andfamily education, direct patient careneeds and community awareness.

American Heart AssociationHeart WalkThis event draws thousands each year.Walkers can "warm up" with a walkthrough our inflatable brain to learnmore about strokes.

Strike Out Stroke withSyracuse MetsWe were happy to deliver a member ofour team to centerfield to throw out thefirst pitch and provide communityeducation throughout the game.

First Annual Stroke CampOur team invited stroke survivors andcaregivers to unwind for a weekend atthe Greek Peak resort.

New York State FairThe Upstate Comprehensive StrokeCenter team volunteers for several daysat the Great New York State Fair eachyear to educate thousands in how torecognize the signs of stroke and howtheir health conditions increase the riskof stroke.

Women's Health and FitnessDayMembers of our team were happy toprovide education and giveaways aspart of this fun community event heldin conjunction with the downtownSyracuse Farmer's Market.

COMMUNITY CONNECTIONS: EDUCATION AND FUNDRAISING FOR

IMPROVEMENTS IN STROKE CARE

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750 East Adams StreetSyracuse, NY 13210

DESIGNATED STROKE CENTER