Supercharged stroke care: How Forsyth Medical Center got so fast

When it comes to treating strokes, doctors put it this way: Time is brain. And the clock started ticking on Amanda Sparks’ brain at 2:45 p.m., March 1, 2024.

At home that afternoon, she grabbed her phone, and twice, it slid out of her palm. "There was no grip," the teaching assistant from Hamptonville recalled. "I hollered for my husband, and I could feel it as I was talking to him — the right side of my face was pulling or sagging."

Scotty Sparks thought his wife, who was recovering from the flu, might be dehydrated, so he gave her something to drink. When it dribbled down her chin, they knew what was wrong.

At 47, Amanda Sparks was having her second stroke in 10 years.

That emergency kickstarted a race against the clock that put 21st century telemedicine to the test. It began at a small hospital near the Sparks' home and culminated less than five hours later with successful removal of a dangerous blood clot from her brain at Novant Health Forsyth Medical Center in Winston-Salem.

Physicians agree: She was at risk of losing the most important part of her brain. But Sparks emerged with no disability and returned to work within a few days.

How did this happen? By harnessing technology that sends information to doctors at warp speed and constantly fine-tuning the choreography of medical teams who work to shave seconds off treatment times as they fight for every brain cell.

"The reason we were so fast in this case is because we had information starting from the moment she entered the first hospital," said neurologist Dr. Colin McDonald, medical director of the Comprehensive Stroke Program at Forsyth and a telemedicine pioneer.

This is a tale of how technology and teamwork speed delivery of lifesaving medical care in under 30 minutes to make Forsyth Medical Center one of the top performing stroke hospitals in the country.

Here’s how Sparks' emergency unfolded in real time:

A quick assessment

Scotty Sparks rushes his wife to Hugh Chatham Hospital in Elkin, their trusted local hospital 15 minutes from their home. As a community medical center, Hugh Chatham offers everything from emergency care to neurological treatment for stroke. When appropriate, the care team also works collaboratively with the stroke team at Forsyth Medical Center.

Shortly before 3:25 p.m., the emergency room doctor at Chatham calls a stroke alert and sends Sparks straight to the CT scanner.

He wants to see what kind of stroke she's having — one caused by a blood vessel that ruptures and bleeds into the brain (hemorrhagic), or one caused by a clot (ischemic). If Sparks has a clot, she's a candidate for a medication that can dissolve it and stop the stroke.

But doctors must move fast: The clot-busting drug must be administered within four and a half hours of a patient's first symptoms.

The radiologist uploads images of Sparks' brain to a secure online platform called Viz.ai that uses artificial intelligence to synchronize stroke care. Every Novant Health stroke specialist has access to Viz.ai on their smartphone. This cuts down on the time it once took to log into networks and platforms to access scans and other information.

By the time Sparks returns to the examining room, a Forsyth-affiliated neurologist who works remotely is at the ready.

This telestroke doctor greets Sparks from a video screen. He recognizes that a stroke is evolving. The online images confirm that her symptoms owe to a clot.

Via video, he obtains Sparks' permission for the Hugh Chatham team to administer tenecteplase, a drug that can dissolve a clot and stop the stroke before circulation fails and brain cells begin to die by the millions. Sparks gets the intravenous injection at 3:47 p.m.

The telestroke doctor quickly orders a scan called a CT angiogram to get a better look at blood vessels supplying oxygen to her brain. These show a clot blocking circulation to 30% of Sparks' brain. He tells Sparks she's headed to Forsyth Medical Center, which is nationally certified to care for patients with complex stroke issues. It's a 43-mile ambulance trip to Winston-Salem.

Preventing a ‘devastating outcome’

Meanwhile, at Forsyth, McDonald gets the call: A patient having an ischemic stroke is on the way. McDonald uses Viz.ai to review the brain images and calls neuro-interventionalist Dr. Don Heck, who does the same. Heck tells the team to strap in.

"She was having a stroke that was going to lead to a devastating outcome if not intervened," McDonald said later.

He prepares to do a quick examination as soon as Sparks rolls through the ER doors. If her symptoms are no better, they'll head straight to the operating room to literally vacuum out the clot.

At 6:57, as a registrar checks her in, McDonald evaluates Sparks. Still on an ambulance stretcher, she's having trouble speaking.

"The reason you've come here," he tells her, “is because we believe that a blood clot has formed in one of the major blood vessels of the brain, and we need to remove that clot using a very minimally invasive operation to get oxygen to where it's supposed to go — and that's going to happen right away."

He points, and his team knows their patient is on the way. At 7:13 p.m., Sparks enters the operating room and is given anesthesia. She's still in street clothes as Heck begins a procedure called a thrombectomy. He threads a catheter through an artery in her groin up into her brain and then advances a wire retriever through the catheter.

His target is the clot – 8-by-5 mm, roughly the size of three pencil points -- in an area of Sparks' brain just above the left ear called the insula. This part of the brain is a control center for language, comprehension, movement on the right side of the body, and even breathing — and it needs oxygen from the blood to do the job.

All function on the right side of Sparks' body is at risk.

There's no time to waste. Every minute a stroke continues, a patient loses 1.9 million nerve cells in the brain. Lasting brain damage, long-term disability and even death may result. That's why doctors say time is brain.

Using the wire retriever, Heck pulls Sparks' clot out through the catheter within minutes. At 7:28, blood flow to her brain is restored. Eight minutes later, the thrombectomy concludes, at 7:36 p.m.

Everyone knows their role

Not so long ago, such a rapid resolution would have been unthinkable, according to McDonald, a founder of a company that pioneered the service in 2005.

Before the current advances, here’s how things worked: Hospital A would have saved the brain images to a CD and sent it with the patient in the ambulance. At receiving Hospital B, the images would have had to be uploaded, viewed and evaluated — as the clock ticked away and brain cells died.

With a shared platform and images they can see on cellphones, today doctors can start treatment as soon as the patient arrives.

At Forsyth Medical Center, the comprehensive stroke team performs these life-saving interventions all the time.

"How did we get so fast? Every team member knows what their role is," McDonald said. "And that's why we have these things that seem miraculous happening every single day at Forsyth." (And in fact, vast swaths of the world still don’t have access to care like this.)

Though Sparks fought off a panic attack on her way to Forsyth, once the ambulance pulled up to the ER, McDonald and his team took charge so fast she had no time to fret.

"I just remember his calming demeanor," she recalled. "They all were just really, really quick on it. It felt like two snaps of a finger and I was out."

Next thing Sparks knew, she was in the recovery room, speaking clearly, much to her husband's relief.

"I remember saying to Scotty, 'I want to go home — this was not on my agenda for March 1, Friday night. I have things to do,' " she recalled with a chuckle.

Doctors weren't ready to let her go quite that fast, however. Sparks spent four days at Forsyth Medical Center as they tested her to learn more about her stroke and how best to move ahead. And, the team is still trying to figure out why it happened. Only about 1 in 7 strokes occur in Americans between 15 and 49 years of age.

Physical and occupational therapists who initially told Sparks to plan for several weeks of rehabilitation were incredulous to find she needed none at all. She left with instructions to take a baby aspirin and a cholesterol-lowering drug every day to help prevent another stroke.

By day 11, Amanda Sparks was back on the job at Moravian Falls Elementary School, shepherding a room full of busy first-graders.

Looking back on it now, it all seems "incredible," she said.

"Forsyth Medical Center," Sparks said, "was just really, really good to me from the time I got there till the day I walked out."