Clad in sky-blue scrubs with one eye on the clock inside Rhode Island Hospital’s operating room, Dr. Ryan McTaggart knows time is the enemy when it comes to stroke care.
Research shows that for every 30-minute delay in stroke treatment, the likelihood of a good outcome drops by 10 to 15 percent. Stroke is the number one cause of disability and the fifth leading cause of death in the United States. A stroke occurs when a vessel in the brain is obstructed by a blood clot or ruptures. “Unlike cancer, we now have a cure for most strokes, and we owe it to our patients to execute this cure and guarantee our patients early access to it. For stroke, there are no second chances and for every minute sooner we open these obstructed blood vessels patients enjoy another week of independent living,” said Dr. McTaggart. Dr. McTaggart is the Director of Interventional Neuroradiology at Rhode Island Hospital and a Radiologist at Rhode Island Medical Imaging. Rhode Island Hospital provides the region’s only Comprehensive Stroke Center. A stroke caused by a blocked blood vessel is called an ischemic stroke, making up about 85 percent of all strokes in the United States. Historically, the only FDA-approved treatment for ischemic strokes is a clot-busting medication called Alteplase or tissue plasminogen activator (tPA). tPA works by dissolving the clot and improving blood flow but has limited efficacy for ischemic strokes caused by obstructions of large blood vessels at the base of the brain known as emergent large vessel occlusions (ELVOs). Even though ELVOs only cause about a third of acute ischemic strokes, they are historically responsible for three-fifths of dependency and nine-tenths of stroke deaths. But the ability to directly remove these clots has revolutionized stroke care. During this procedure, known as a mechanical thrombectomy, a physician deploys a device called a stent-retriever through a microcatheter (a hollow plastic tube) to grab and remove the clot. The procedure has proven extremely effective in limiting the risk of death and disability when used to treat blockages in the larger vessels leading to the brain. In fact, there are very few things in medicine with as powerful a treatment effect as mechanical thrombectomy for ELVO stroke, said Dr. McTaggart. Last year the American Heart Association/American Stroke Association issued new treatment guidelines establishing mechanical thrombectomy as standard of care for ELVO stroke. “My mission in coming to Rhode Island is to improve early access to thrombectomy and leave no ELVO behind,” said Dr. McTaggart. “It’s a two-pronged approach that prioritizes getting patients to the right place the first time by empowering EMS professionals to determine where stroke patients need to be triaged while also encouraging collaboration with other hospitals to better protocolize stroke care so the diagnosis is never missed.” “Stent retriever technology has revolutionized stroke care delivery within our region,” said Dr. McTaggart. “We’re the only hospital in the area to offer this procedure, so we needed to put systems into place to get patients here quickly.” Rhode Island was the first state in the US to have a law that empowers EMS to transport all patients with suspected ELVO stroke to Rhode Island’s only Comprehensive Stroke Center. According to Dr. McTaggart, research shows that patients with access to stent retriever technology in addition to tPA are twice as likely to be functionally independent at 90 days versus patients who receive tPA alone. Before joining Rhode Island Hospital in 2015, Dr. McTaggart worked at The Cleveland Clinic. “Based on the remarkable improvement ELVO outcomes have, the Rhode Island Ambulance Service Advisory Board recently voted to eliminate the 30 minute transport time threshold so that all patients with suspected ELVO – anywhere in the Rhode Island – will now be transported to the right place, the first time,” stated Dr. McTaggart. For Dr. McTaggart, persistent healthcare inefficiency and inequality drives him to deliver the very best life-saving care for all. “My mission in life is to make sure that everyone gets the same level of care and has access to mechanical thrombectomy — I feel I owe it to Rhode Island,” said Dr. McTaggart. Improving and transforming systems of care is also what motivated him to partner with the Southern New England American Heart Association. Dr. McTaggart is the 2019 Heart and Stroke Ball Chair. “People should come to the 2019 Heart and Stroke Ball this year to celebrate the incredible work being done in Rhode Island to continue to improve stroke care,” said Dr. McTaggart. He credits the hard work of EMS professionals, nurses and doctors (both at Lifespan and partnering health care organizations) with changing stroke care delivery here. “Rhode Island is leading the world in stroke care delivery right now and you’ll learn how and why at the Heart and Stroke Ball,” said Dr. McTaggart. “But we need to push the system further – we have an incredible opportunity to use technology and digital health to improve stroke care delivery and transform the overall cardiovascular health of our population.” Dr. McTaggart has been honored with the 2018 Rhode Island Hospital Community Service Award for his leadership and contribution to humanitarian services with his stroke care program. Dr. McTaggart is a graduate of the College of Physicians and Surgeons at Columbia University and completed his residency at The Warren Alpert Medical School of Brown University. He completed a diagnostic neuroradiology fellowship and an interventional neuroradiology fellowship at Stanford University. Dr. McTaggart is an Associate Professor at The Warren Alpert Medical School of Brown University. This year’s 2019 Southern New England Heart and Stroke Ball will take place on Friday, September 27 at the Providence Biltmore Hotel. For more information on table and ticket sales please contact Heart Ball Director Donovan Evans at [email protected] or 352-246-1911.
