Unmatched by Previous Stroke Treatments, Thrombectomy Dramatically Improves Outcomes
By BECKY GILLETTE
Interventional Neuroradiologist Mark Moss provides leading edge procedure for stroke victims
Stroke is the leading cause of adult disabilities and the fifth leading cause of death in the U.S. In Northwest Arkansas, stroke victims have access to leading edge stroke treatments including endovascular thrombectomy that can quickly and effectively treat stroke victims so they can return to their normal lives, sometimes within a day.
Mark Moss, MD, an interventional neuroradiologist at Washington Regional's Northwest Arkansas Neuroscience Institute in Fayetteville, said a series of well-conducted randomized trials in 2015 concluded convincingly that endovascular thrombectomy dramatically improved the outcomes of eligible patients with strokes from a large vessel occlusion.
"The success of endovascular therapy for ischemic stroke treatment (thrombectomy) is now irrefutable, making it an accepted standard of care," Moss said. "It is very gratifying to have patients who were previously unable to talk or move their arm to shake your hand and say, 'Thanks,' sometimes immediately after the procedure."
When a patient arrives with symptoms of a severe stroke, protocols are initiated to ensure immediate evaluation by ER personnel and stroke neurology which includes advanced brain imaging. Eligible patients will then receive the clot busting drug alteplase and/or proceed to the neurointerventional radiology suite for thrombectomy.
The time window for stroke endovascular therapy plays an important role in the clinical outcome. A new major recommendation increases the time window from 6 hours to 24 hours for selected patients with acute ischemic stroke to receive mechanical thrombectomy. Moss said the new recommendation will result in more patients becoming eligible for thrombectomy since more patients will be treated based on clinical presentation and advanced imaging rather than a time cut-off alone.
Moss graduated from the University of Arkansas for Medical Sciences College of Medicine in 2000, and completed his medical internship, radiology residency and neuroradiology fellowship at UAMS. At age 46, inspired by the remarkable developments in the field of endovascular neurosurgery witnessed in the past decade, he did an endovascular neurosurgery fellowship at the Medical University of South Carolina.
His family, wife Wendy and daughters Madylin and Isabelle, stayed behind in Fayetteville while he did his second fellowship.
"It was very hard leaving them for 18 months, but it would have been virtually impossible to convince my teenage daughters to leave their friends, especially for my older daughter who was going into her senior year of high school," Moss said. "Thankfully, I have a very supporting strong family."
Moss said the thrombectomy procedure is a safe, but complex procedure that requires an experienced team to deliver and needs to be performed with great rapidity. Moss works with Mehmet Akdol, MD, who is also an interventional neuroradiologist, at the Northwest Arkansas Neuroscience Institute clinic, which is located adjacent to Washington Regional Medical Center. In addition to treating stroke, Moss and Akdol offer minimally invasive options for diagnosing and treating conditions of the brain, neck and spine including brain aneurysm and arteriovenous malformation. Using specialized imaging guidance and a small incision, the interventional neuroradiologists can perform complex procedures without open surgery - allowing patients to recover more quickly.
"We are very fortunate at Washington Regional Medical Center to have two dedicated state-of-the-art biplane neurointerventional radiology suites, as well as a full staff of highly skilled nurses and technicians," Moss said. "We also have a dedicated 20-bed neuro intensive care unit. My partner, Dr. Akdol, and I provide 24/7 365 days a year coverage for neuro intervention."
Other procedures they do include treating atherosclerosis of the brain and neck with angioplasty and stenting. And they use embolization to treat aneurysms, blood vessel malformations and tumors. The aneurysm treatment is also called aneurysm coiling or flow diversion (pipeline stent). The coils or stent are used to block flow into the aneurysm to prevent it from rupturing, producing bleeding and brain damage.
Moss said the ongoing development of endovascular tools has led to successful treatments of lesions once deemed non-operable or only surgically approachable.
There is a very short recovery time for patients treated for a unruptured aneurysm, dural arteriovenous fistula and arteriovenous malformation embolization. Typically, these patients spend one night in the hospital for observation and go home the next day.
Moss, who grew up in Russellville, became interested in medicine at an early age. "Growing up, many of my parents' friends were physicians, and my mom and dad would often tell me how much they respected them and what they do," Moss said. "One of these friends happened to be a radiologist and under his guidance I began volunteering at our local hospital during my freshman year at high school, which furthered my interest in the medical field."
Moss said there are many people who have influenced him.
"My parents instilled in me the virtue of hard work and that nothing comes easy," Moss said. "My wife and daughters are amazing people I am so grateful for. Throughout my medical career, I have been privileged to learn and work with many gifted physicians such as Dr. Eddie Angtuaco - a brilliant passionate man who inspired me to be the best I could be."
During his free time, his interests include alpine and rock climbing, hiking, wake surfing and landscaping.
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