Justin Mascitelli, MD, Assistant Professor of Neurosurgery at the University of Texas at San Antonio talks about RAPID stroke technology.
Interview conducted by Ivanhoe Broadcast News in September 2018.
So we did the interview with the patient this morning. She got incredibly lucky and you happened to be in the general vicinity. Tell us from that point what happened with the cell phone intervention.
Dr. Mascitelli: I had just finished an aneurysm coiling and I was checking my e-mail on my phone in the control room when I saw a new RAPID e-mail about a 65 year old woman with a right sided middle cerebral artery occlusion. The strange thing about it was that I had not received a phone call yet from any neurologist or ER physician, it was a patient that I did not know about. I immediately stopped what I was doing and walked across the hallway to the emergency room and I found Ms. Novier there in the emergency room. I’m sure the emergency room was getting ready to call me as they were awaiting the results. It just so happened that the results got to me before it got to them. And so I found the patient who was having the stroke and we immediately activated the stroke system. We got the room changed over, cleaned, and I wheeled the patient over to the interventional suite and basically put her on the table myself for the procedure.
How much time had passed from when you got the e-mail to when she was on the table?
Dr. Mascitelli: I think it was less than 20 minutes or maybe 20 to 30 minutes. We had to clean the room, quickly put together the table to perform her procedure, and then I had to go get her and put her on the table. It all happened very quickly.
She’s so incredibly grateful, as is her husband, but what kind of satisfaction do you get as a physician when something like that happens?
Dr. Mascitelli: This is as good as it gets. I mean, this is why you do the job. I’m incredibly fortunate to have this job and to be able to do this. To take a patient who’s about to have a large stroke and essentially reverse it— there’s really no better satisfaction within the field.
What type of stroke did she have?
Dr. Mascitelli: She had an occlusion of her middle cerebral artery on the right side and if that had gone on to complete the stroke in that territory, essentially the vast majority of the right hemisphere of the brain would have sustained a stroke.
In other words, it would blow up and bleed out?
Dr. Mascitelli: Not so much a bleed, but a lack of oxygen to that part of the brain resulting in brain death of those brain cells and likely a permanent inability to move the left side of her body.
So, to get the terminology correct, she had a stroke and the intervention where you took the clot out prevented a major one?
Dr. Mascitelli: Right. She had an occlusion of one of the major arteries of her brain. She was in the process of having a stroke and our intervention was able to greatly reduce the amount of stroke that she ultimately had. She did ultimately have some stroke in the brain, but it was very small compared to what could have been the final result had we not opened that artery up.
I want to go back to the 2015 thing in a minute, but I want to stay on this for a second because this was done on your cell phone. Think about this compared to ten years ago and give us a scenario. Or let’s say two years ago.
Dr. Mascitelli: I actually don’t know exactly when the RAPID software came in to play. This is my first experience using it. I didn’t have it in my training, but it’s very useful. The images get sent directly to your e-mail and everyone has e-mail on their phone now. So within five minutes of the imaging being completed, I get an e-mail directly on my phone that has the vascular imaging of the brain and in certain circumstances, the profusion of the brain, giving us more information about what tissue is viable and which tissue has already had a stroke.
Is the term RAPID referencing development time or transmission time to the e-mail or both?
Dr. Mascitelli: I think RAPID is just the name of the software. It probably has an acronym, but it probably was named that way because you do get the images rapidly.
So her outcome was very, very positive. She told us that it was like an out of body experience. She could hear everybody around her and a couple of times she thought she was talking but the words weren’t really coming out. It reminds me of people who die and see themselves in the afterlife. What’s happening to a patient? What’s happening inside their head?
Dr. Mascitelli: It’s hard for me to know for sure because I’m lucky to have not had a stroke, but I think certain people have written about having a stroke and then coming back from it. There’s definitely some recognition that something bad is occurring, but it’s hard to put it all together. Her stroke was on the right side of her brain which is generally the non-dominant side of the brain, which means that she probably had a better understanding of what was going on versus patients who have a stroke on the left side of their brain which greatly affects their speech and their ability to understand speech. So most likely there are two different experiences for patients who have dominant strokes versus non-dominant strokes.
Your cell phone’s got a little bitty screen compared to, say, that screen, but you can still see everything on your screen that you need to see. Describe that to us.
Dr. Mascitelli: You’ve got a picture on your screen just like any picture on your iPhone. You can use your hands to zoom in and when it’s a large vessel occlusion and you’re kind of used to looking at these pictures, it doesn’t take that much time to figure out that this patient has a large vessel occlusion and they definitely need that vessel re-vascularized, unless the patient has already gone on to have a stroke.
So you said that your previous hospital in New York didn’t have the RAPID software. How was the process different?
Dr. Mascitelli: I did my endovascular training from 2013 to 2015 in New York and we had all the same imaging ability. We just did not use the RAPID software at that time during my training, so we would get the images, but we just wouldn’t be able to get them on our phone in a kind of instantaneous fashion.
So you would get the images.
Dr. Mascitelli: We would have to either be at the hospital or be on a computer that could connect to the hospital system and then we would look the patient up and look at the images that way.
Let’s say you’re at home and this happened and you didn’t have the RAPID. It takes a lot of time to log in to the system.
Dr. Mascitelli: Yeah, it definitely adds on a number of minutes to both open up your computer and log in to the system, but there’s also extra time needed to process the images. So I think the benefit is that it’s a rapid processing of the images and rapid sending of the images to the providers.
So let’s go back to 2015. Until then, intervention was not predominant.
Dr. Mascitelli: Well, stroke has been prevalent for a very long time obviously and intervention for a stroke has been available for a very long time. It really had not been proven until five clinical trials came out in 2015 in the New England Journal of Medicine, demonstrating that patients really had a great benefit from this intervention. The trials that had gone on prior to that did not show a benefit and, therefore, intervention wasn’t proven as helpful.
What did they do prior to then?
Dr. Mascitelli: Intervention was done in select cases. It wasn’t the norm and it was done by practitioners who believed in the intervention. It just wasn’t believed in across the medical community.
Considering your position as a doctor in this particular case, what do you think about technology and all of the things it can do combined with the doctoring profession?
Dr. Mascitelli: I think it’s great. It’s really a benefit to be able to access the imaging rapidly in order to make a decision. Every minute counts in patients that are having a stroke, so anytime you can shave off a minute here a minute there, you’re saving brain cells and you’re doing the patient a benefit.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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