Telemedicine Stroke Program Saves Woman

While suffering a major stroke at her home near Mena, Iva Sikes assumed the worst, not knowing that a University of Arkansas for Medical Sciences (UAMS)-led telemedicine program would provide her a complete recovery.

Sikes, who lives alone four miles outside of Mena, was about to tend her flower garden June 1 when the left side of her body went numb, causing her to fall.

Her only hope of recovery was to get the right diagnosis from a stroke neurologist so she could receive t-PA, the only FDA-approved drug that could break up the blood clot that was starving her brain of oxygen and nutrients.

And it had to be done within three hours.

Sikes, 89, was wearing a lifeline, a communication device that allowed her to summon her grandson and an ambulance.

“I was sinking fast,” she said just 10 days after the stroke. “I told my grandson, ‘I’ll not be here long.’ My body, my mind, everything was sinking.”

Had her stroke occurred just nine months ago, her chance of recovery would have been slim, said Salah Keyrouz, M.D., Sikes’ stroke neurologist at UAMS.

Starting Nov. 1, Mena Regional Hospital was among the first of now nine hospitals to join the Arkansas SAVES (Stroke Assistance Through Virtual Emergency Support) program, which links rural hospitals to stroke specialists at UAMS and Sparks Health System in Fort Smith. The program is administered by the UAMS Center for Distance Health, which was created by Curtis Lowery, M.D., chairman of the UAMS Department of Obstetrics and Gynecology.

Stroke neurologists are on call 24 hours a day, and remote hospitals participate at no cost.

Keyrouz, medical director of the SAVES program, took the call from the Mena hospital after Sikes arrived. He was able to communicate via real-time two-way video with the local hospital medical staff and Sikes. He also was able to view her high-definition brain CT images taken at the hospital.

“In addition to her left-side paralysis, she had lost peripheral vision on the left side, too,” Keyrouz said. “I knew then that she had a large stroke.”

Despite her advanced age, Keyrouz determined that she was a good candidate for the clot-busting t-PA. It was important that Sikes was able to tell him definitively that the stroke had occurred at 9:30 a.m., which meant the drug could be given within the critical three-hour window. Patients who wake up with a stroke, for example, and don’t know when the stroke began are not eligible to receive t-PA.

“If you can intervene very early on, there’s a chance that you can melt the blood clot by giving this very powerful medicine,” Keyrouz said. “If you do it beyond three hours, there is potential that you’re irrigating an area of the brain that’s irreversibly dead. The risk of bleeding is also high.”

Sikes and her family agreed to the t-PA treatment after Keyrouz informed them that it would give her roughly a 30 percent chance of improvement, but a 2 percent to 6 percent chance of bleeding in the brain.