When she arrived to us, she couldn't speak.

She was totally weak on the right side of her body.

So yesterday was July 4th.

Today is what?

We are January.

July.

July 15th.

Fifth.

July.

Right.

She started to notice she was having stroke symptoms.

So the fact that she was able to recognize very quickly, like, oh, I'm having a stroke and I need to get help now.

Definitely helped in her recovery.

And do the other hand, same thing.

Okay good.

Of all the neurological conditions Stroke is the most common and it's the most common disabling condition for adults.

When someone has a stroke, generally it does not hurt.

We transported a patient today.

That patient was saying all the way to the hospital I don't want to go to the hospital.

So when people have strokes, they tend to blow it off.

Every minute is 2 million brain cells that die.

If we save a minute with saving a week of disability if we save an hour were saving a year of disability.

In stroke time is brain.

Support for this program comes from Genentech.

Genentech is committed to advancing scientific understanding and supporting educational programing.

Genentech joins Public Broadcasting in celebrating the history of progress in stroke care.

And by Penumbra Inc.

A stroke can happen at any moment.

Getting help fast makes all the difference.

Penumbra develops technologies that help doctors get patients back to the lives they love.

Learn more at penumbrainc.com.

And by HCA HealthONE in Denver.

Learn how HCA HealthONE Swedish is working to set the standard for stroke treatmen nationwide at hcahealthone.com.

We are proud to support science education on public broadcasting and by Neurologica.

A Samsung company.

We're driving to the vault where the art of my grandfather Anton Raederscheidt is lying.

Anton Raederscheidt, Lucienne and Laurences grandfather was a modernist painter labeled a degenerate artist by the Nazis.

Raederscheidt short lived in exile before eventually returning to his hometown, Cologne.

In the late 1960s stroke was considered untreatable.

Victims had no warning and no real hope for recovery.

Almost everyone can remember a family member, friend or colleague who suffered the same affliction.

Anton had a stroke in 1967.

Afterwards he... Well, his art was completely different.

So we have some of the paintings after his stroke that actually showcased quite good what happened to him and his art.

So with these pictures, you can really see what happened to him after his stroke It's really weird just getting to know your grandfather just through art.

But still, he had such a great influence on our lives and on our childhood that we struggled.

I mean, he never he was never able to then tell any one of us how it was to have the stroke.

But we can see it.

Stroke is no longer untreatable.

Over the past several decades, we have begun to understand what a stroke is, how it can be treated, and how it can be avoided.

During that time, medical science and clinical neurology have made giant strides.

But the path was not always straightforward.

The journey often required passion and daring by researchers and doctors from around the globe.

Unexpected discoveries and key insights revolutionized our encounter with a disease once thought of as a fate worse than death.

The word stroke is based on an old belief that an afflicted person had been struck down, as if by the hand of God.

They felt unconscious within a few seconds.

They didn't move.

The limbs were paralyzed, and very often these patients died within a few days.

If we talk about ancient medicine, the human body was a black box, especially the brain.

We now know that a stroke is an injury to the brain, the organ that controls almost everything you do and feel, and that makes you, you.

Billions and billions of brain cells called neurons generate electrical signals that communicate with other neurons and your entire body through trillions of connections called synapses.

Those signals require a lot of power, which is delivered by blood in the form of oxygen and glucose.

What happens is that a blood clot is sitting in a blood vessel that supplies the brain with blood, and because that blood clot is there, that aspect that aspect of the brain doesn't get the nutrients or the oxygen that it needs to survive and thrive.

And all of a sudden it was like I just typed a word and it was really hard to type.

And I am like backed up and like typing and to try to type it again.

I'm like, just what's wrong?

It affected her memory it affected her speech.

That's one of the most devastating things that can happen to someone.

And one second they're normal, the next second they're paralyzed or unable to talk.

There are two basic types of stroke.

One is caused by the rupture of an artery in the brain.

The spilled blood damages the brain.

This is the hemorrhagic stroke, but around 90% of strokes are caused by a blood clot in one of the brain's arteries, which starves part of the brain of nutrients.

This is an Ischemic stroke.

Stroke was considered, an untreatable condition in the 1970s.

We didn't even know how to prevent it Follow my finger with your eyes.

The first challenges to treating a stroke or identifying what type of stroke it is, where it is located, or even if it is a stroke at all.

The next challenge is what can we do about it?

For a millennia, there was no therapy.

The Greeks, the Egyptians, medieval times, the modern era.

The first three quarters of the 20th century.

No therapy for this dread.

Common disease.

Neurology was seen as a diagnostic discipline, not a therapeutic discipline.

Stroke, especially, was the epitome of the non-treatable illness.

Patients coming in devastated and being put to the side of the emergency department because we didn't have a treatment for them.

As late as the 1970s.

Doctors believed there might never be a treatment for ischemic stroke, as it was widely believed that neurons only survived a few minutes without a continuous supply of oxygen and glucose.

Then, in the in the last quarter of the 20th century, there were breakthroughs.

Doctors became fully convinced that heart attacks and strokes were due to blood clots obstructing an artery.

A glimmer of hope appeared with the discovery that not all brain cells are irreversibly damaged within the first few minutes of an ischemia stroke.

We knew that nerve cells that had no blood flow died within a minute or two, and that was the core, the small area of the brain that dies very early or is already dead.

And then there is the surrounding zone, which is dysfunctional and threatened but still salvageable.

And that's in astronomical terms, the penumbra, the shadow.

The concept of the ischemic penumbra was described by neurologist Jean-Claude Baron, whose work revealed that stroke was not always an immediate death sentence for brain tissue.

That was a major revolution in stroke management, going from nothing zero to some hope.

The brain cells within this penumbra might stop functioning normally, but they will not die outright.

And so, of course, time is of essence, making sure to open up that blood vessel so that we can promptly and effectively get those tissues which are stunned, so to speak, to now wake up again and, resume their function.

And I'm just going to see if you can hold it up there for me.

Okay.

Brain as our command center governs different aspects of our bodily functions.

So how a stroke manifests all depends on what part of the brain is affected.

Can you lift that left arm for me?

Able to hold that up in the air?

It might be the inability to move.

So yesterday was July 4th.

Today is what?

We are.

January.

July.

It might be the inability to talk, to understand what's being said.

Can you follow my finger with your eyes?

It might be the inability to see or recognize objects, whatever the particular part of the brain is that is affected by the stroke will determine what the symptoms of that stroke are.

The German artist Anton Raederscheidt, whom we encountered earlier, had his stroke before there was any understanding of stroke and its potential treatments.

His stroke affected his visual perception.

He could no longer recognize nor draw a portion of the world.

We see failure to fill in the form of the face and body on the left side of face, and its as though that half of the world no longer exists.

And in the part of where the patient is seeing things, it's a very schematic.

Broad picture without, great detail.

My name is Désiré Collen I'm a retired professor of medicine of the University of Leuven in Belgium, where I basically have worked my whole career.

Professor Collen's research and life's work focused on the biology of blood, including how blood clots form and dissolve.

In out body we have two complementary systems.

One is the coagulation system that produces blood clots so that you don't bleed, profusely after cutting a blood vessel.

The counterpart of the clotting system is the fibrin analytic system, where the solid substance of a blood clot has to be removed as to be broken down.

And that breakdown is brought about by a protein that is called Plasmin.

The balancing of this system is very important for maintaining our normal functions.

Depending on where that clot is located.

A clot in a cardiac artery causes a heart attack.

A clot in a brain artery causes an ischemic stroke.

For decades, scientists had been searching for effective ways to treat heart attacks, a leading cause of death.

Blood thinners might help, but also might cause uncontrollable bleeding elsewhere.

The answer was found in an unexpected place.

A team of researchers in New York had discovered a group of cancer cells that produced a substance that seemed to dissolve clots.

When Désiré Collen heard about this discovery, he requested a sample.

He understands it has some affinity for fibrin, which is the stuff of blood clots.

And at that point, the light bulb goes off in his head and he recognizes now that he has, a substance that people have been looking for for a couple of decades.

In science, what's spectacular is not usually some kind of exploding test tube or fireworks, but what goes on inside the scientists head.

Collen had discovered how the body removes a clot without causing bleeding elsewhere.

An enzyme called tissue plasminogen activator, or TPA, binds to the clot and causes plasmin, a protein already in the blood, to dissolve the clot.

TPA is a molecule that occurs normally in our blood, but in such tiny amounts that it was basically impossible to purify enough of it out of human blood.

How do you make enough of this molecule and package it in such a way that it will work once you give it to human beings, and that had not ever been done before.

The solution depended on the audacious work of a young biomedical scientist, Diane Pennica.

How did I get involved in the TPA story?

Basically, it was a combination of luck and fate, and sometimes it's the trivial things that you do that can change your life.

And it happened for me.

I went to a congress in Malmö in Sweden.

While I was making a presentation.

There was a young lady entering the room.

She was Diane Pennica, and he talked about having this melanoma cell line that produced TPA.

He had purified protein, and I realized that I was in the right place.

Turns out by mistake, I had walked into a private pre-conference session of all the top scientists in the heart disease field, and I wasn't supposed to be there.

They didn't ask me to leave because they thought I was one of the scientists daughters waiting for her dad, and she introduces herself.

They go to dinner and she says, you know what I can do?

I can clone the gene.

I was initially a bit, a little bit reluctant because TPA is a very large molecule.

At that time, in 1980, no molecule of any way comparable to the size of TPA had ever been cloned.

And I quickly told Desiree and that dinner.

Sure, I can clone TPA.

And I think my enthusiasm helped convince him to work with us.

But I have to admit, I had never cloned anything before.

I had no idea how to do it, and I didn't know if it could be done.

The amount of TP that Désiré Collen could produce in his laboratory in Belgium was minuscule.

What Pennica was proposing was to clone the treatment and make it possible to produce it on an industrial scale that would allow it to be used as a therapy for heart attack, for any number of conditions where you needed to dissolve clots.

In only two years, Diane Pennica and her team succeeded.

I looked down one day and I found this small stretch and I started shaking and I said, oh my gosh, I think we found the clone.

We were about to know the structure of this protein for the first time.

In 1982.

On July 23rd, I went to a sixth International Congress on Fibrinolysis in Lausanne, Switzerland, to announce that we had cloned TPA.

And this was the same conference that I had snuck into that private meeting two years earlier.

And it was one of the most exciting moments of my career.

So it was quite the breakthrough.

It required the kind of science that you grind it out.

You come into the lab.

Hour after hour, day after day, and make it happen.

I had great respect for her tenacity, for her devotion to the project, and she really deserves the credit for making that... in those days, heroic achievement of cloning such a huge big molecule in that short amount of time.

In 1987, TPA was officially approved as a treatment for heart attacks.

Soon, scientists began to consider TPA as a possible treatment for ischemic stroke.

Two new medical studies out tonight confirm a major advance in the treatment of strokes.

The NINDS, TPA stroke trial was to accomplish one specific goal a clear cut, definitive clinical trial of the thrombotic therapy TPA for acute stroke.

They purposefully picked people like me that were early in their career.

And let's just say, had something to prove.

And that ended up being the key to success because we knocked down walls to to get the job done.

To give this treatment to patients as quickly as we could to find an effective therapy for stroke.

Some of these patients, within the next hour or so, after giving the TPA, suddenly their paralysis would get better and they would start to talk and they would stay better.

Those of us doing the trial, we knew we were seeing something different.

This was the moment that would that would change my life and change my career personally if it worked, because it would change the outcomes for millions of stroke victims around the world.

There was a lot of enthusiasm and excitement when we finally enrolled the last patient in the trial.

We were very excited to get the results.

Each of those end points was positive in favor of the TPA over placebo.

The room, you know, burst into applause and cheering and everybody, you know, hugged one another.

I'm getting tearing up myself, remembering it because it was a very emotional event.

We all went outside and I remember looking up and there was an airplane flying overhead, and it just seemed like it was a sign or some sort of omen.

We knew that the world of stroke, and not just the world of stroke, the world of neurology, had changed at that moment.

The NIH called a press conference, and they asked me to make this first statement to the press.

Yesterday the stroke was an untreatable disease.

Today, I'll show you the first conclusive evidence of an effective treatment for the most common type of stroke.

Positive results of the trial changed the world of stroke and neurology forever.

It showed us that getting the clot dissolved and getting the artery open was the way we could, make a difference in stroke outcomes.

It really resulted in a sea change in the treatment of acute stroke.

Up until that point, there was no reason for the neurologist to get out of bed at night.

There was no reason for the emergency room to act with any alacrity when a stroke patient came in because there wasn't any acute treatment that was going to make any difference.

All of a sudden there was a drug which, if administered within three hours of the onset of symptoms, could make a huge difference in a person's life.

We could take a stroke patient paralyzed on one side, unable to see, unable to speak, give them this treatment, and they could walk out of the hospital completely normal.

That's revolutionary.

I'm Bill Meehan, and I'm coming into Denver, Colorado, where back in October 1st, I had a stroke.

I went to the 24 hour fitness gym.

I felt fine at the time, and as I was loading it up with weight, I then relaxed and started to work out, but immediately lost mobility of my right side and fell immediately to the ground.

I was loaded on to a helicopter.

Any time that happens, you got to think to yourself, this isn't a good situation.

And I thought literally, I was done.

When you come into the hospital as an emergency with an acute blocked artery stroke, there's a whole lot of chaos.

Time is brain.

Minutes matter.

We're rushing you to CAT scan.

We're doing IVs.

We're asking questions.

We have only 20 minutes from the time you arrive to the time we want to start that clot buster treatment.

The CT scan has become an invaluable tool in the emergency room.

A scan can reveal whether a stroke is ischemic or hemorrhagic.

If the stroke is ischemic, the CT scan can show where the clot is located.

How large it is.

How much of the brain is beyond help, and how much is penumbra and still salvageable?

This information is crucial because not all strokes can be helped with clot dissolves.

The thrombotic drugs like TPA were a revolution, but they worked imperfectly and it turns out that the size of the clot matters a lot.

If you have a small clot high up in the brain, TPA works very well.

If you have a big clot in the neck and in the lower part of the brain vessels only a small amount, the drug arrives there and they can't digest that large clot very well.

Such a clot requires an invasive procedure called intra-arterial thrombectomy.

And you go in there with a device and you literally pull the clot out of the artery, and you open it up and you restore blood flow.

It's kind of like the difference between pouring Drano in your drain and going in with the snake.

We access either a wrist artery or there are over the head called a femoral artery.

With a catheter we call a sheath.

So we get access to the arterial system in the body.

We go directly up to the artery that's blocked.

And we just put a catheter directly against the clot.

Turn on a suction pump and suck the clot out.

And we can actually go in there and get that artery open.

And they can walk out of the hospital a day later.

After having the CT scan.

I came down and was identified having inclusion in my left quadrant of my brain.

So they quickly brought me down here to the interventional room to remove the clot.

Do you notices different now from before If anything?

You know, I'm capable of doing basically anything.

Thank you so much for saving my life.

My name is Doctor Erica Stoddard.

I'm a fourth year neurology resident, which means that I'm in my final year of residency.

My kind of first moments of making the decision to go into medical school happened around the time my grandmother got sick, and I just remember the care that the doctors had when she was in the hospital, the care that she required after getting out of the hospital.

And that kind of pushed me towards the medical field.

Not a lot of women, especially women of color, get into this field, but we're starting to see changes in that.

But first, I'm happy for my thing with your eyes.

Look all the way over here and just look.

And then over here.

Good.

Can you lift both arms up off the bed right in front of you?

Kind of like Frankenstein.

So up in the air.

Good.

Turn up, palms up like you're holding a big tray.

And then close your eyes and keep them up.

Just like that.

Okay, good.

Well, let us know if you feel any more dizziness spells, okay, perfect.

Thank you very much.

All righty.

Thank you.

That's one, two, three.

I was able to scrub in on a thrombectomy case.

And I remember watching this patient unable to move the entire right side of the body, unable to speak.

We pulled that clot out, and minutes later, the patient's able to lift their arm up off of the bed.

They're able to start saying a few words and I my eyes lit up and I was like, I need to do this.

I got a lesson with Doctor Frei, a well-known neuro interventionist, in the removal of a left M1 occlusion.

This is an exciting field.

We're making a difference every day, and human lives.

I mean, this is something that medical students and residents in the neurosciences, they're clamoring to come into this subspecialty, and I can understand it.

Put the wire forward.

It's exciting.

It's impactful.

It's cutting edge technology.

You're helping patients.

Going into the guided catheter and then tracking up towards the clot.

Yeah.

So the larger the inner diameter, the larger the power of aspiration.

So I think we're really just now on the forefront of an explosion.

And the technology of neuro interventional treatment of any neuro disease.

When I was in training, our chief used to like to say, don't just do something.

Stand there.

That's what a neurologist should do.

But of course, that's absolutely the wrong way to treat acute stroke.

We now know because you can't wait.

I'm proud to say neurology moved very quickly and faster than other specialties.

And in meeting this change, a complete change in lifestyle.

The discovery of the penumbra revealed a larger time window for intervention than originally thought.

Still, the sooner a patient can be treated, the better the outcome.

The longer the blood supply is interrupted, the more disabling the stroke and the lower the chance of reversing its effects.

Time is brain.

And when you run the numbers, it turns out that every minute that goes by in a typical acute ischemic stroke, the human brain loses 2 million nerve cells.

It also loses the synapses, the connections that let one nerve cell talk to another.

It loses 14 billion synapses every minute.

And the long fibers, the myelinated fibers that let one region of the brain talk to another.

We lose seven and a half miles of myelinated fibers every minute that goes by.

Thrombectomy can restore blood flow blockages caused by larger, more devastating blood clots.

But not every hospital has the resources or personnel to offer such treatments.

But obviously that takes skill.

It takes a lot of training, and it takes some very expensive equipment to be able to provide that service to people.

You have a we call a neuro interventionist, a physician who's trained for 7 to 8 years after they get out of medical school to do this.

You have technologists in the room to handle all the equipment, and then you have a nurse and you may have an anesthesiologist.

These rooms are incredibly expensive.

You're having five highly trained people there and an instant notice to do these treatments.

The advent of thrombectomy got lots of people thinking about the best way to provide thrombectomy is to the acute stroke patients.

The initial concept was that there would be a few centers that were capable of doing this, and the trick was to get the patient to that center as quickly as possible.

But one size doesn't fit all.

One of the things that we do here is actually try to bring the doctor, the team that can do the thrombectomy, to the patient.

My name is Joanna Fifi.

I'm associate director of the Cerebrovascular Center.

We would oftentimes get calls that there was a patient with an MCA occlusion, for instance, downtown.

The process of transferring patients that became apparent was taking up too much time.

You know, we like to say time is brain.

And so that's that's a lot of time.

And we would be sitting waiting for the patient.

We decided to go there and treat the patients on site.

And we noticed a big time savings.

We started doing it at one hospital.

And then we've set up a site in Queens and then at Brooklyn that our team does now travel to, to treat the patients on site.

I mean, in New York City, it works well because we we're able to get to our various hospitals.

You know, within half an hour.

We call the system MIST, Mobile Interventional Stroke Team.

And we compared patients where we transferred them in patients where we traveled to.

And we saved over an hour in actually door to puncture, door to recanalization.

And we were able to show improvement in clinical outcomes in long term clinical outcomes.

So all the thrombectomy, that we do in a year.

It's about a third that's treated in the Comprehensive Stroke Center.

The rest are treated at these satellite sites.

This is the entrance to the stroke center.

We hope to have ambulances draw right at this entrance.

The patient can be brought in on a stretcher by EMS and place assessed quickly by the emergency room staff, and then placed directly on this table.

This table turns and the CAT scan is right there.

Each geography is going to have its own, optimum way to set up the system.

This system of satellite facilities works well in areas where doctors have multiple transportation options to get to their patients.

But what if a patient is in a remote setting without proper facilities that can be easily accessed by a neurologist or a neurosurgeon?

One of the challenges in dealing with urban and rural areas is the idea of access to care.

When we have hospitals that are in rural areas with limited resources, one of the biggest tools we have is what we call consulting.

I'm Chris Fanale, stroke neurologist.

I'm the medical director for Blue Sky Telehealth, as well as Blue Sky Neurology I am coming here because I can't get my word together.

In places where patients don't have the access to stroke neurologist.

We use telemedicine to visually look at these patients, evaluate these patients, and make a better decision.

And if we were to just talk to people over the phone.

often, there's not even board certified ER physicians.

It's the community physicians.

When patients come in with more complex presentations like stroke.

Okay.

And can you lift up your right leg for me?

Medicine is so super specialized right now.

No one can keep up, but they're often going to want to have a resource, have a neurologist from a comprehensive stroke center or primary stroke center to help them.

Hey, definitely some weakness, I think on that left leg as well.

Yeah, it seems like maybe consistent with the right MCA stroke syndrome.

I agree.

What would you like to do doctor Fanale?

Some of these decisions that we make are life altering.

And so I think that we feel everyone feels more comfortable, having that telemedicine as a back up, two way communication and video conferencing via the internet has made remote diagnosis possible.

Telemedicine saves time, and brain cells even hundreds of miles away.

The patient can be stabilized, assessed, diagnosed and readied for treatment where they are or transported to a better equipped location.

Hi there, Mr.

Smith.

I'm Doctor Luyten and I'm an emergency physician.

All right, Mr.

Smith, can you close your eyes for me.

The neurologist ability to drive the camera angle to zoom in on the patient's pupils, to hear the patient they can perform, I think, a pretty detailed and accurate neurologic exam.

I want you to lift both your arms straight up off the back for me.

Like this.

They're able to use their expertise to advise whether you need the clot busting drug and if we should put them on a helicopter and get them to our specialist hospital as quickly as possible.

Yeah, we're clear to start.

And resources will not be the same everywhere we go.

There are resources at a higher level facilities.

The lower level facilities will not have.

But the idea of coordinating that care is essential.

One of the great breakthroughs that we made at our facility was introducing this concept of the launch pad.

So what the launch pad means is that the patient who is arriving from outside the hospital with a pre-hospital team stays on the pre-hospital pram.

Once a patient gets to a room, they tend to stay there.

And there's a lot of inertia.

Once a once a patient is in a room, the patient really doesn't benefit from being put on to a hospital bed or being moved into a hospital room.

In fact, it only slows things down.

Hi.

Mr.

Smith.

Good morning.

I'm doctor Spencer, okay.

I'm one of the neurologist.

Right.

How are you feeling?

So now, rather than going to a room, we have a little spot when a stroke alert is called to the launch pad overhead to the neurology teams already there.

The EMS crew arrives with the patient on their pram.

They give their report to the neurologist and we keep the patient on the pram.

When you guys are, we head over to CT The patient is then whisked off with the EMS crew.

We probably shave 15 minutes easily off of our time to get that patient into CAT scanner.

Literally every minute counts, and time is brain.

The left middle cerebral artery is included.

So this is a great candidate for thrombectomy.

So let's go.

What's really unique about stroke is how varied its presentation can be.

Nobody's coming in with a sticker on their forehead that says, I'm having a stroke.

And so there's often actually a diagnostic challenge.

What we've discovered is that stroke occurs across all ages.

It's presentation is a little different in the very young, the young and the elderly or the very old, but that we can achieve good outcomes at all ages.

But we have to be fairly tailore in our treatment.

My name is Anna Madaris.

We are here in New York City and I'm a health correspondent.

When it comes to the stroke stories, a lot of it has really just come to me.

More and more families were coming to me with stories of their young people, strokes that have happened to them, and they wanted their stories to be told as well.

We're on the way to Nutley, New Jersey, to visit Xavier and his family.

This is Erica.

Hi, so nice to meet you.

Thanks for letting us come to your home.

Welcome to my house.

And this is X here.

This must be X. so nice to meet you.

I wanted to share that we are an everyday family.

And, you know, a stroke is something that can affect anyone.

He's struggling.

Xavier, his, happy young adult.

When we were home, he was okay.

In the morning.

I get home the afternoon we're having dinner.

He was like, no, I'm not feeling well.

I'm not going to lay down.

A few minutes after he lay down, he was having a seizure.

They took him to the hospital and.

That day, you know, they said he's not breathing.

He wants to be intubated.

That was when the doctor said, that they found a clog.

I couldn't believe it.

Disbelief, definitely.

Because, you know, under the presumption that these things happen to the elderly.

Not, Not the young.

You know, all our family is forever changed.

And it's just like the pain is immense.

It's not something you could hold back.

In every stroke.

Time is the enemy.

When a patient reaches the emergency room, the race begins.

Assess, diagnose and treat.

The faster a patient can be diagnosed and treated, the better the outcome.

Time is brain.

But what if the race didn't have to start at the hospital?

One solution is the mobile stroke unit.

In Germany, medical professionals such as doctor Professor Heinrich Audebert have rethought practices of stroke care, bringing the hospital directly to the stroke victim.

If you want to improve something, actually you can't wait for the patient.

Actually, we have to bring a little bit of the hospital to the patient in order to be quicker, in order to be more effective and to to improve patients, particularly with thrombotic treatment.

When I came to Berlin, we established a very good relationship with the Berlin Fire Department that is responsible for the emergency medical services here in Berlin.

And this was why we designed a special ambulance in order to work on identifying acute stroke patients in the emergency call.

And then we started the mobile stroke unit as an ambulance with, CT scanner, with point of care laboratory and also with telemedicine, a CT scanner on board the ambulance accomplishes several goals.

If the clot is small, clot dissolving treatment can begin almost immediately.

If the patient requires a thrombectomy for a larger clot, the ambulance can be sent directly to a stroke treatment center that provides the specialized procedure.

MSU is actually dispatched to the patients.

That patients have much better outcomes over the scale of global disability and death, which was really a very relevant improvement.

We were able to treat patients much faster, and that translated to substantially more patients recovering from their stroke.

We were approached by a doctor Grotta, one of the iconic figures in acute stroke here, and we had very fruitful discussions.

How did you become aware, of of our group, of our activities here?

We had I had a visiting fellow here, actually.

Advances in communication technology have also led to improvements in international cooperation between colleagues together.

Complex problems can be solved even though the collaborators are an ocean apart.

So here's the inside of our, mobile stroke treatment unit.

As you can see, it's a little bit different than what a traditional ambulance looks like.

And one of the main pieces that differs is the CT scanner.

So this is our, in touch telehealth monitor.

This is where our, tell a stroke physician is able to beam in, pretty much from any place that they have a wireless signal on their laptop.

They're able to see real time.

The patient, help us do an assessment and give guidance and orders, in real time on seeing with our patients as well.

Working with the telemedicine has just really revolutionized what we can do.

Being able to have our physician, with us on calls allows us to bring treatment to the patient.

Even just talking about it gives me goosebumps because it's amazing.

Well the mobile stroke unit promises to be a major advance in how we manage stroke patients.

Brain cells die in direct relationship to how long that artery is blocked off.

We have to do brain imaging and be able to look at the brain substance with an x ray before we can deliver the stroke treatment, so we can get the artery open much earlier and hopefully save that left side of the brain before paralysis occur.

It doubles the chance of recovery without disability by getting a patient treated in that first hour.

Compared to out to three to four and an half hours.

My name is Satoshi Tateshima.

I'm a professor of interventional neurology.

When I joined the team here, I saw a lot of new technology devices being developed.

That was fascinating.

I witnessed it, and I wanted to be part of it.

Despite the advances in research and treatment, many stroke victims do not have fast enough access.

In the US, for example.

Only a fraction of patients that could be treated with a thrombectomy actually receive this vital operation.

The obstacle to get treated is lack of awareness.

They have to come to the hospital.

The second obstacle is these countries.

Too huge.

To bridge this gap is the focus of doctor Tateshima Research.

He is developing techniques that will allow a surgeon to do a thrombectomy remotely.

So, yeah, this is our robotic system.

And here's the cassette and the.

We have a catheter here.

Now, already we are controlling catheters outside of the room.

That's like 20ft away.

Using the same technology, we can make it 2000 miles away.

What's happening?

In the robotic surgery is exactly like a mega car plant.

It's a robotic arm connected to the catheter that control the catheter and that control to wire.

Using this robotic capability, we can provide the care to the patient.

As an eight year old.

I was sick, and I couldn't move my hands.

I couldn't move my legs.

I couldn't feel anything.

The community hospital said, hey, this kid is dying.

My parents were told, of course, they couldn't give up.

One medical school accepted me and they provided the latest care.

Then I survived.

And then when I got discharged and I saw my dad, big smile on his face, then I realized something really good happened to me.

And then I thought, whoa.

You know, being a surgeon or being a physician would be a great thing.

Then I decided to go to medical school.

Very same medical school where they saved me.

So by pushing this, joystick.

We are pushing out the wire.

In the future, I hope I can provide a stroke care to anywhere in the world?

40 years ago, my doctors didn't give up, and I want to do the same thing.

If there is even little hope, I really do not give up.

What have you learned so far about our patient?

Is there a focal neurologic deficit?

Yes.

We need neurologists more than probably any other specialty in all of medicine.

Given that there's so much that we can do to transform people's lives, though research on stroke care continues by visionary and committed scientists and medical professionals.

The American Academy of Neurology has projected that by 2030, most states in this country will not have enough neurologists to meet the demand for neurologic care.

We took a group of third and fourth year medical students, all of whom had never seen a stroke code before in their entire lives, and we had them simulate a stroke code from beginning to end.

Any surgeries that you've had recently?

Oh, I'm sorry if this hurts.

I'm really sorry.

I just want to see if you can move and really push on.

Okay.

And I think the patient was, young, healthy man who suddenly fell to the floor, couldn't move the left side, and was having trouble with the normal visual input to the brain.

The patient is an actor who has been trained in the the signs and symptoms that are really important for the student to be able to learn to identify.

What blood pressure do we need to get to... over?

Okay, everyone said stroke care is the ultimate team sport, so it was really important for the students to experience that.

Today, students work in two teams, each assessing the patient.

In one team, they were trying to get all the information from the EMS worker who brought the patient in from the patient's roommate and from the patient himself.

Could this patient be having a stroke that we could actually treat with life saving therapy?

And then he brought that breakfast to the couch.

And this is about 7 a.m.

And then I saw him sluff over.

What have you learned so far about our patient?

Can you see how many fingers I'm holding up.

Vital signs?

The students are working to perform an NIH stroke scale, which is a very fast and universal assessment to help us understand the severity of one's stroke.

Using the NIH stroke scale.

A stroke team can determine the patient's ability to move, see, and communicate.

There's nobody standing there.

The resulting score indicates the severity of a stroke.

And trying to situate the craft of neurology itself is very challenging.

Neuroanatomy is one of the most difficult subjects that students face.

Talking to patients who take a neurologic history and examining patients to perform neurologic exam.

Probably one of the most challenging sets of skills that students have to learn in all of medical school.

Yes.

Okay.

And so we think this is a pretty severe stroke.

It's so important for students to see just what we could do, how we can transform the lives of the patients that we get to treat as neurologists and stroke neurologists.

The thing that matters the most is recognizing what an emergency, a stroke is.

And there's a number of patients who show up hours, if not days later, with symptoms that may have been helped and they gotten here a little sooner.

We have an acronym called Fast FAST, and FAST stands for F, meaning facial drooping.

A stands for arm weakness.

Weakness of an arm.

S stands for difficulty with speaking, difficulty with speech, and T stands for time.

The importance of calling 911.

Once you or a family member or somebody around you recognizes that this might be a stroke.

One of the biggest barriers that we face is people understanding that this is an emergency, and it can be fixed.

A lot of people can really minimize it.

They ignore it, and then it it evolves and they're out of a treatment window and it's devastating.

Err on the side of caution.

It's better to be safe than sorry and get to the hospital as fast as you can.

Every minute that that care is delayed, the likelihood of having a good outcome is decreasing.

You see someone having a stroke symptoms.

Call 911.

It can make a tremendous difference in their lives.

I'm coming in from the airport in Houston, and I'm hoping to talk to doctor Grotta Come on in, guys.

This is our mobile stroke unit.

My goodness.

Here's the CT scanner.

Stephanie is show you around.

She's the director of the program.

So I recently learned that if patients were treated in the mobile stroke unit within the first hour, which is called the golden hour, that their outcome is much better than if they were treated within the timeframe of 3 to 4 hours in the mobile stroke unit.

It was pretty emotional for me to see the end result of all the work that I had done, getting choked up.

I think about all the patients who've been who've been treated now, and whose lives have been saved, and that they no longer have to go into a nursing home or a rehab facilities.

It's just incredible.

Over the past 30 or 40 years, science, medicine and technology have made great strides in the diagnosis and treatment of stroke.

Still, stroke remains the second leading cause of death worldwide and the main cause of lifelong disability, primarily because victims of stroke do not get proper treatment in time.

If you, a friend, a colleague or loved one, experience any symptoms of stroke.

It is imperative that you get help immediately.

Time is brain.

Support for this program comes from Genentech.

Genentech is committed to advancing scientific understanding and supporting educational programing.

Genentech joins Public Broadcasting in celebrating the history of progress in stroke care.

And by Penumbra Inc.

A stroke can happen at any moment.

Getting help fast makes all the difference.

Penumbra develops technologies that help doctors get patients back to the lives they love.

Learn more at penumbrainc.com.

And by HCA HealthONE in Denver.

Learn how HCA HealthONE Swedis is working to set the standard for stroke treatmen nationwide at hcahealthone.com.

We are proud to support science education on public broadcasting.