Adventist Health Glendale | Healthline Quarterly | Early Spring 2018

IT WAS A SUMMER TUESDAY at 9:48 AM when Glendale Fire Department paramedics rushed Silvana Shirvanian, 60, to Adventist Health Glendale’s emergency department. Her left side was weak. One side of her face was drooping. Her speech was slurred. These are all classic signs of a stroke. On Thursday, Shirvanian got dressed and was discharged. She literally walked out of the hospi- tal and regained her strength, just like nothing ever happened. Of course, not every stroke patient has such an amazing outcome, but scenarios like Shirvanian’s are be- coming more common at Adventist Health Glendale—a credit to the expertise of neuro-interventional surgeons Yaser Badr, MD, and Mikayel Grigoryan, MD, and an extraordinary stroke support team that goes into action when a patient enters the hospital. ‘We didn’t give up on her’ Upon arrival, emergency physician Sylvia Kotikian, MD, immediately asked Shirvanian when the onset of the stroke occurred. The previous night, about 8:30 PM, Excellence and teamwork Among those connected to Silvana Shirvanian’s care are Yaser Badr, MD; Sylvia Kotikian, MD; ER nurse Gail Mather, RN; CT/MRI supervisor Rafael Rodriguez; radiologist Kaveh Soleimanpour, MD; catheterization lab staff members Anthony Akamine, Freddy Martin, RN, and Vladamir Zamallomoa; ICU nurse Brian Yparraguirre, RN; and NTU nurse Lara Kumjian, RN. Pictured at right, Shirvanian celebrates with more of the cath lab staff members. From left are Tess Luna, RN; Jose Chavez, RN; Shirvanian; Travis Vitto, RN; Daniel Castro; and Mark Iniego, RN. Stroke patient regains strength— in just two days! explained Shirvanian’s sister. She had discovered Shirva- nian the next morning, lying on her bathroom floor and unable to get up while screaming for help. Thirteen hours had elapsed—way past time for tPA, a clot-busting medication injected within 4½ hours of the onset of a stroke. In many hospitals, 13 hours is past the time for any acute evaluation and intervention. “We didn’t give up on her,” recalls Michelle Jocson, the hospital’s stroke program manager. “Adventist Health Glendale is a comprehensive stroke center, and our protocols follow the latest evidence-based guide- lines. We look at a patient’s symptoms within a 24-hour period.” Every patient who comes in with a stroke that began within 24 hours receives a CT scan of the brain and CT angiography of the head and neck, explains Jocson. “The contrast used in the angiography determines where the clot is.” By 10:14 AM, CT exams identified the cause of Shirvanian’s stroke: an emergent large vessel occlu- sion, or blockage, of the middle artery leading to her brain. ‘Stentriever is a game-changer’ By 10:36 AM, Shirvanian arrived at the catheterization lab, where Dr. Badr—who was on call that morning—and the stroke team were ready for action. A tiny catheter was inserted through the groin and threaded through major vessels up into the brain. When the catheter reached the clot, a pliable coiled stent, called a stentriever, was expanded to open and intermesh with the blockage. The clot adhered to the coils, and then both the stent and the clot were carefully removed—just like that! By 11:47 AM, normal blood flow was restored to the affected portion of Shirvanian’s brain. “The stentriever is a game-changer,” Jocson says. “In the past eight months, we have done 34 of these proce- dures [also known as thrombectomies]. By comparison, other major hospitals reported about 40 thrombectomies during the whole year of 2016.” On Thursday afternoon, just two days after having a stroke and entering the emergency room, Shirvanian walked throughout the hospital sharing emotional hugs of joy with her doctors, nurses, and cath lab and ER staff. They couldn’t believe their eyes! Medical director Mikayel Grigoryan, MD (left), and Yaser Badr, MD, with patient Silvana Shirvanian. CT/MRI supervisor Rafael Rodriguez and radiologist Kaveh Soleimanpour, MD. TO L E A R N MO R E A B O U T A D V E N T I S T H E A LT H G L E N D A L E O R TO F I N D A D O C TO R , V I S I T A D V E N T I S T H E A LT H G L E N D A L E . O R G 3 STROKE CARE