RPA's comprehensive stroke service makes all the difference to stroke patients.
When Marina Chiovetti woke up feeling dizzy and unwell, she thought she was having a migraine.
The 42-year-old digital transformation leader went to work as usual and attended a meeting, when she developed double vision.
“At the end of the meeting, I went to shake hands with a colleague and suddenly there was two of him,” Ms Chiovetti said.
Deciding to call a taxi home, Ms Chiovetti was leaving her office when the colleague mentioned the word stroke.
It reminded her of a friend in her native Canada who years earlier had a stroke at age 17 and was left with permanent limited mobility.
“I knew that if there was anything major was going on I had a limited window,” she said.
As she headed home, Ms Chiovetti called her partner James Brett, who was about to get on stage to launch his latest book.
“I said, I always have to listen to you, this time, you have to listen to me. You need to get yourself checked out,” Mr Brett said.
Ms Chiovetti went to her GP, who immediately called an ambulance. The stroke team at RPA was alerted and ready to take her for a CT scan on arrival.
The stroke team determined Ms Chiovetti, who was otherwise fit and well, was having an ischaemic stroke, which occurs when a blood clot blocks an artery and interrupts blood flow to the brain.
Because more than four and a half hours had passed since she became unwell, Marina was no longer eligible for intravenous thrombolysis, known as clot-busting drugs.
But the multidisciplinary stroke team at RPA determined she did meet specific criteria to undergo endovascular clot retrieval (ECR), an innovative, complex and delicate procedure that reduces disability and is potentially curative.
ECR restores blood flow to the brain in patients with larger clots that cause the most devastating strokes. The clot occluding a brain vessel is removed through an intra-arterial approach by a team including an anaesthetist, neurointerventional radiologist, neurologist, intensivist and specialist nursing staff in an angiography suite. It can be done up to 24 hours after the onset of a stroke.
RPA Director of Stroke Associate Professor John Worthington said recent clinical trials showed that in patients with large clots, who are candidates for this treatment, on average about one in three recover almost completely, being independent three months after the stroke.
Associate Professor Worthington said Ms Chiovetti is one of those fortunate third who will avoid any disability or need for rehabilitation. Her blurred vision is expected to subside in a few weeks.
“She has had an excellent outcome when this stroke could have been devastating,” Associate Professor Worthington said.
Of all the neurological disorders, stroke is the largest single cause of adult disability. Currently, around 56,000 Australians have a stroke each year; more than 100 every day. While the rates of people dying from stroke have dropped significantly in the last 30 years, around half the stroke survivors alive today suffer from a disability affecting their daily life.
RPA is one of only two sites in Sydney to offer 24/7 ECR. In April 2017, the RPA Comprehensive Stroke Service was launched, which created a state-wide referral process. This year, 126 patients have received ECR, including 84 patients transferred in from across NSW.
Sydney Local Health District Chief Executive Dr Teresa Anderson AM said providing equitable access to stroke thrombolysis and ECR across a state as large as NSW has required great investment in equipment, imaging software, staff training and telehealth systems.
“It showcases what is possible when a team of people come together determined to provide the very best in care possible to the people who need it, no matter who they are or where they come from,” she said.
Ms Chiovetti will now consult Associate Professor Worthington in the new Young Stroke clinic he is establishing for stroke patients under age 50. Of the 420,000 survivors living in our community 30 per cent are under 65.
She is grateful to the ambulance and hospital staff, and to her colleagues and partner, who urged her to see urgent medical treatment.
“I know there is a very small window and if we hadn’t acted things would have been considerably worse,” she said.
“I still can’t believe I had a stroke.”
National Stroke Week (September 3 to 9, 2018) is a timely reminder of the F.A.S.T test to check for the most common signs of stroke.
Face: Check their face. Has their mouth drooped?
Arms: Can they lift both arms?
Speech: Is their speech slurred? Do they understand you?
Time: Is critical. If you see any of these signs call 000 straight away.
For more information, see strokefoundation.org.au