Behind The Scenes

At 7:50 a.m., in a room on the fourth floor of University of Cincinnati Medical Center, a team of neurologists and neuro-interventionists are discussing brain scans displayed on the wall in front of them.

While each scan tells a different story, they all have one thing in common—every patient whose image is shown has suffered a stroke.

A beep pierces the air. Pooja Khatri, MD, co-director of the University of Cincinnati Stroke Team, hops up from her seat and leaves the room. She pulls out her cell phone and dials the number shown on the pager that she will carry until 5 p.m. that day.

“Hi, this is Dr. Khatri with the stroke team,” she says.

The voice on the other line answers in a measured yet urgent tone. She is calling from another Cincinnati hospital about a patient they just received through their emergency department.

This patient went to sleep the night before like any other night. When he awoke that morning, he was experiencing telltale signs of a stroke.

Dr. Khatri asks the woman on the other line to send over the patient’s scans as soon as they are available.

“If he’s got a clot, we’ll helicopter him over here,” she says.

She thanks the woman on the other line and reenters the meeting. Within 15 minutes, she is able to access the patient’s scans on a computer in the corner of the room. Dr. Khatri and another physician review them together, searching for a place where blood has stopped moving through the brain’s vessels.

If the clot is big enough, neuro-interventionists can thread a small tube through an artery in the patient’s leg up to the brain and pull it out.

Dr. Khatri shakes her head.

“No clot for us to take out, unfortunately,” Dr. Khatri, back out in the hallway, tells the woman at the other hospital on the phone.

“Oh, that’s a shame,” she replies.

But there’s still hope.

Just a year ago, doctors would have agreed that there was no feasible treatment for this patient. Because this patient went to bed fine and woke up with symptoms, there’s no way to tell how long ago the stroke occurred. In stroke care, time is everything.

But in late 2018, new research showed that tissue plasminogen activator (tPA)—the “clot busting” medication—could be effective in treating stroke within four and a half hours of symptom recognition in some patients, even if it is beyond four and half hours from when the patient was last known well.

“If I can get an acute MRI, I think it will be worth it,” Dr. Khatri says.

“If we fly him there, we can get him there in 20 minutes to get that MRI,” the voice on the other phone answers.

It’s decisions like these that Dr. Khatri and the stroke team make every day—not just for patients who come through the doors of the Emergency Department, but for every person in Greater Cincinnati that has a stroke.

Dr. Khatri, her stroke team co-director Opeolu Adeoye, MD, and 14 others take turns carrying a pager every hour of every day.

Hospitals around the region are known to call this pager anytime they encounter a patient who they even suspect may be having a stroke. The UC physician on stroke call helps inform these other physicians which patients may benefit from which treatments, and whether they need to be sent to UC Medical Center.

That kind of citywide care only happens in Cincinnati.

“We’re unique because our stroke team has been working across the health systems for the entire region for the benefit of patients since the late ‘80s,” said Dr. Khatri, UC Health neurologist and neurology professor at the UC College of Medicine.

What happened in the late 1980s shook the international medical world, changed the way we treat stroke and saved countless lives: UC neurologists piloted the use of tPA, a drug already approved for heart blockages, to treat stroke.

It was a huge success, positioning UC and UC Health as world leaders in stroke care and triggering decades of research to continue to save and improve lives for people who have strokes—research that continues to this day.

Someone in New York or London or Tokyo who receives tPA, or whose clot is removed through their artery, is able to receive this care in large part because of the giants at UC Health who have dedicated their lives to this work.

“We’ve got this history of treating stroke in this city, and that’s why I came here,” Dr. Khatri said. “I’ve lived all over, but I wanted to do my fellowship here.”

She stayed with UC and UC Health to follow through stroke research she started during that fellowship.

“If you ask my kids why we’re living in Cincinnati, they’ll say, “Because mom was doing the IMS (interventional management of stroke) trial.”

UC and UC Health play a significant role in the international field of stroke treatment and care:

• UC leads the clinical coordination of nearly all of the nation's large-scale, multi-center stroke trials funded by the National Institutes for Health.

• The UC Stroke Team created the widely known “FAST” acronym—face, arms, speech and time—to determine whether you’re having a stroke. “FAST” is now recognized as the American Stroke Association’s guidelines for recognizing a stroke.

• The stroke team helped develop the National Institutes of Health Stroke Scale, a scoring system that allows physicians everywhere to communicate stroke severity with consistency.

For those patients who do come through the UC Medical Center Emergency Department, their journey with UC Health has only just begun.

The patient who Dr. Khatri suspected may have a tiny clot is brought into the department entrance on a stretcher and immediately taken into an imaging suite.

An entire team of people—Dr. Khatri, radiology technicians, nurses, emergency medicine physicians, residents, and a UC medical student—will now care for this patient, informed by the world’s most up-to-date stroke research.

Dr. Adeoye is one of these emergency medicine physicians who is waiting and ready when a stroke patient arrives.

“What we do on the stroke team is a multidisciplinary endeavor, starting in the pre-hospital environment, through the emergency department, involving neurology, involving radiology, neurosurgery or neuro-interventionalists, to be able to communicate with all the people potentially involved in the care to ensure we deliver optimal care to the patient,” said Dr. Adeoye, associate professor of emergency medicine at the UC College of Medicine.

Because Dr. Adeoye specializes in stroke care—a condition that is always an emergency—he is able to help make patients’ care journeys seamless. He speaks that language.

Dr. Adeoye is building upon decades of research now by leading a study to determine whether tPA works better in combination with other drugs.

It’s a nearly $30 million study funded by the National Institutes of Health—a landmark amount for the Emergency Department. The answer will guide Dr. Adeoye and Dr. Khatri—and the rest of the world—in the years to come.

“Dr. Khatri and I have worked together over 10 years at this point,” he said. “We know each other well, we know how to communicate effectively with each other, and that all adds up to benefit the individual patient who comes in.”