Advanced Stroke Care at Monument Health
Dr. Jae Kim & Dr. Lien Diep
By Alex Strauss
Stroke can be debilitating - and even deadly - no matter where it occurs. But when a stroke happens in an area without ready access to neurointerventional stroke specialists and cutting-edge clot retrieval technology, the risk is even higher. Until recently, that was the situation for many Black Hills area stroke victims.
"In the time it takes to send someone to Sioux Falls for neurointerventional treatment, lives were being lost," says neurologist Lien Diep, MD, medical director of Monument Health's new stroke program. "And sometimes people don't want to leave town anyway. Some elderly patients would rather die than travel. They give up too soon just because they don't have money for a helicopter or for a hotel in another town."
Stroke treatment at Monument Health has advanced rapidly in recent years. Last year, Monument Health Rapid City Hospital received the American Heart Association’s Silver Get With The Guidelines – Stroke Quality Achievement Award for 2020, a testament to their commitment to following national, research-based guidelines.
But where stroke is concerned, Diep says 'time is brain'. Millions of brain cells may be lost for every minute of impeded blood flow. Diep and her colleagues are determined to save brain cells and lives by taking stroke care at Monument to the next level. They are building a comprehensive stroke program to advance and coordinate care from the earliest stages of diagnosis to rehabilitation and recovery.
"Before I came, everyone was working independently," says Dr. Diep. "What we needed was to bring them together in a more cohesive way. The stroke program does not belong to neurologists only. I came here to help connect the dots."
Building a Stroke Team
One critical step on the path to a comprehensive stroke program in the Black Hills was the addition of interventional neurologist Jae Kim, MD. Dr. Kim moved from Sioux Falls to Rapid City last spring to join the Monument Health Neurology and Rehabilitation Clinic. He is an interventional neurovascular specialist who performs clot retrievals, aneurysm care, and a broad range of interventions for blocked and ruptured blood vessels in the brain.
"I have been working with Monument Health on a referral basis for several years," says Dr. Kim. "What I noticed over the last couple of years is that the number of patients who need neurointerventions has been increasing. But there was a lack of specialty care West River. I came to Monument because I saw what they were creating and I wanted to be part of that growth."
"My goal was always to have neurointervention here, but I knew there needed to be certain things in place first," says Dr. Diep. "We worked with the cardiologists to help bring in CT perfusion and we negotiated with the radiologists to get biplane cineangiography for our new hybrid operating room. Things came together over time. When I felt we had the right pieces in place, that's when I reached out to bring Dr. Kim here."
New Technology & the Hybrid OR
Rapid City Hospital's new hybrid operating room is an advanced procedural space that combines a traditional operating room with an image-guided interventional suite. Dr. Kim says it can streamline workflows and provide a safe experience for patients.
"If something like an aneurysm happens while we are doing angiography and we decide we need neurosurgical expertise, instead of the patient having to be transferred to another OR, the neurosurgeon can come to our hybrid room and transform it from an IR room to an OR room," says Dr. Kim. "It is a very important piece of the puzzle."
The room is home to a state-of-the art biplane cineangiography system which produces sophisticated real-time, three-dimensional imaging of vessels deeps in the head and neck. The biplane represents a significant leap forward in allowing physicians to diagnose neurological abnormalities and treat them with minimally invasive endovascular procedures.
"We have some dramatic stories thanks to this equipment," says Dr. Diep. " We had an 85-year-old farmer come in with an occlusion. He was out working and he just dropped. Even TPA could not fix that. But 45 minutes after Dr. Kim got to him, he was walking again."
The hospital will soon also have access to rapid AI software that will allow Dr. Kim to diagnose an occlusion in a patient at a referring hospital within seconds of a CT scan, potentially expediting the transfer of patients who need thrombectomy.
Toward a Comprehensive Program
While the program is not yet certified by the Joint Commission as a Comprehensive Stroke Center, they are well on their way.
The hospital is carefully tracking metrics to show an improvement in the time it takes to open occluded vessels. They will also need to establish a dedicated neurointensive care unit and bring in a second neurointerventionalist. Dr. Diep says it is all in the works.
"We have all the pieces in place and I am confident that we are going to get there," says Dr. Diep, who is anxious to spread the word about the program's capabilities to referring physicians throughout the Black Hills
"My protocol is, if people need help, bring them over here," she says. "Don't wait. Let us decide if it's a stroke. We don't want to deny saving lives."