A breakthrough in stroke care – for all of us

Donor support helped MUSC turn a long-held dream into a bold blueprint. Coming soon: The BAT Cave — a future-forward space that could cut stroke treatment time in half.

Every minute counts when you’re having a stroke.

The faster doctors can diagnose and treat you, the better your chances of surviving — and walking away with little or no lasting damage. In stroke care, time is brain. Every second can mean the difference between independence and lifelong impairment.

Thanks to years of investment and innovation, South Carolina is already a national success story. In 2008, donor support from The Duke Endowment helped launch a statewide telehealth program that transformed stroke care. We went from some of the worst treatment times in the country to among the best.

Now, MUSC is ready to do it again.

With donor support, the next breakthrough is already underway: a first-of-its-kind treatment space that will cut stroke response time in half – and benefit every South Carolinian who suffers a stroke.

South Carolina’s stroke care turnaround

In 2008, The Duke Endowment funded a bold idea: connecting South Carolina patients to lifesaving stroke care via live video.

That investment launched one of the country’s most ambitious stroke telemedicine programs –linking rural hospitals and clinics to internationally-recognized stroke specialists at MUSC in real time. Today, it reaches all 46 counties.

MUSC is home to South Carolina’s first Comprehensive Stroke Center, certified by The Joint Commission, and the only one in the state to earn the Stroke Gold Plus Quality Achievement Award from the American Heart Association/American Stroke Association. It is the highest level of certification for hospitals qualified to handle the most complex stroke cases.

“South Carolina has made a tremendous improvement over the last decade with getting treatments to people in rural communities,” said stroke neurologist Christine Holmstedt, D.O., medical director of the MUSC Stroke and Telestroke programs. “A hundred percent of the state is now within a 30-minute drive of an expert stroke doctor via telemedicine.”

Why fast isn’t fast enough

But even with fast diagnosis through telemedicine – and some of the best stroke treatment times in the nation – a critical delay remains: what happens once the patient gets through the hospital doors.

At MUSC One West, a stroke patient is rushed from the ambulance bay straight to the emergency department’s dedicated CT scanner. Advanced brain imaging is completed within minutes of arrival.

If a clot is detected, treatment begins immediately. A clot-busting drug may be injected through an IV, or the patient may be prepped for emergency surgery.

Then the wait begins.

The patient is transferred back to a stretcher. Monitors and IVs are reconnected. The care team stands by, waiting for the green light from the interventional neuroradiology suite – located on the sixth floor of Rutledge Tower – where specialists like neurosurgeon Alejandro Spiotta, M.D., are prepared to physically remove the clot from the brain’s blood vessels.

To reach the suite, the team navigates internal hospital corridors to the main elevators. They ride up to the second floor, where a skybridge crosses over Ashley Avenue into Rutledge Tower. From there, they take another elevator up to the sixth floor, where the interventional neuroradiology suite is located.

Total time from arrival to intervention: 60 to 70 minutes.

“That's better than most comprehensive stroke centers around the nation,” Holmstedt said. “But we want to cut that in half – because every minute is nearly two million neurons lost.”

What’s slowing treatment today

For years, Holmstedt and her team have envisioned a better way – a way that keeps stroke patients in place and eliminates precious minutes lost in transport.

“Can you imagine if we didn’t have to move the patient across the hospital into a different building, up two different elevators?” she said.

So why do they? Because the tools needed to perform these life-saving procedures can’t just be installed anywhere.

The biplane angiography system – a ceiling-mounted, multi-million-dollar machine – uses two rotating X-ray arms to capture real-time, high-resolution images of the brain’s blood vessels from multiple angles. It’s essential for procedures like mechanical thrombectomy, where doctors guide catheters through arteries to remove the clot.

“This is really sophisticated, heavy-duty equipment that looks like a fighter jet,” Spiotta said.

The system requires lead-lined walls for radiation protection, reinforced floors, specialized power sources and dedicated ventilation systems.

“It's a huge undertaking to install one right next to the emergency department,” he said.

An undertaking that’s about to become reality – because of donor support.

A new ‘one-stop shop’ model, years in the making

“We dreamt this years ago,” Holmstedt said. “As far back as 2017, we were saying we need a single, one-stop shop for stroke patients.”

That’s the vision behind MUSC’s BAT Cave. A hybrid, donor-supported treatment suite designed to eliminate delays and bring every part of advanced stroke care – imaging, diagnosis and intervention – into a single, high-tech space just steps from the ambulance bay.

BAT is short for “brain attack team.” And “cave?” Spiotta says it’s a nod to the shift from higher floors – where these procedures traditionally took place – to a custom-built suite on the ground level, closer to where patients first arrive.

“BAT is a code word for hyper-urgent stroke response,” Spiotta said. “And we’re moving from the third and sixth floors to the first. So, it’s the BAT Cave.”

And with the equipment on the ground floor, the patient never leaves the CT table.

“We're going down to them and doing surgery on the spot,” Spiotta said. “We can get the artery open 30 to 45 minutes faster. For the brain, that’s an eternity.”

With this model, Holmstedt says MUSC can cut treatment time in half.

“It's huge,” she said. “Very few centers are doing this. The ones that are have had incredible results.”

MUSC will be among the first – because of donor support.

A donor’s vision becomes a statewide solution

Elizabeth “Lisa” Schultz, M.D., didn’t set out to transform stroke care in South Carolina.

A retired internal medicine physician, Dr. Schultz saw a growing need closer to home: her community on Kiawah Island lacked accessible health care services.

“It’s a long drive if you’re going downtown often for care,” she said. “But in an emergency, that kind of distance from lifesaving treatment is a real concern.”

When she first approached the MUSC Foundation, her plan was to support MUSC Health Kiawah Partners Pavilion, a medical facility designed to serve the growing and aging population of the Sea Islands. But then she learned about the critical need for a dedicated stroke suite in downtown Charleston and its potential to improve outcomes for patients across the Sea Islands and in communities throughout South Carolina.

Spiotta walked her through the journey stroke patients currently face.

“He showed me the angio suite and the equipment they use,” Schultz said. “There was a space near the emergency department that could potentially be converted into a dedicated BAT Cave. It seemed like a perfect opportunity.”

Schultz worked with Brian Panique, senior director of principal gifts at the MUSC Foundation, to set up a five-year pledge to support the BAT Cave. Her commitment provided critical early funding to move the project forward.

“What really struck me is that Dr. Schultz had a real big desire to make sure that everyone benefits from this,” Holmstedt said. “I couldn't be more grateful for the gift that she's giving.”

For Dr. Schultz, the decision to give came from a deep understanding of medicine, and a belief in using her resources to serve others.

“It’s a wonderful feeling to be able to help other people,”

she said. “We’re here to be a community and help those who don’t have all the advantages some of us do.”

The BAT Cave: From concept to construction

Early planning for the BAT Cave began in spring 2025. A feasibility study was completed over the summer, and construction is now moving forward – bringing the one-room stroke suite one step closer to reality.

The team is working closely with architects, engineers and clinical leaders to create a custom-built space that meets both the technical demands of stroke intervention and the speed required for emergency care.

“We’re on the cutting edge,” Holmstedt said. “I see this becoming a model for hospitals, nationally and internationally.”

What started as a dream is now a blueprint. And what donor support made possible in 2008, it’s making possible again.

“Philanthropy doesn’t just make projects possible – it makes them happen faster,” Spiotta said. “

It can speed things up by five or 10 years. The support we’ve received is incredibly valuable – and we’re deeply grateful.”

What this means for South Carolina

Stroke remains one of the leading causes of serious long-term disability and is consistently among the top five causes of death in South Carolina.

Professionally and personally, Spiotta is committed to changing that.

“Stroke affects so many people every day,” he said. “I’ve had a family member impacted. An initiative like this is going to reduce a lot of disabilities and lead to real breakthroughs.”

And the BAT Cave won’t just transform care at MUSC – it will strengthen care across the state.

For many hospitals in South Carolina, MUSC is the closest expert stroke center. Thanks to telemedicine, doctors can spot severe strokes early and quickly refer patients. But once they arrive, valuable time can still be lost.

The BAT Cave will change that, allowing MUSC to begin treatment the moment the patient arrives. That means faster care and better chances of recovery, no matter where the stroke occurs.

Holmstedt believes this model could make MUSC the most efficient stroke destination in the region – even for patients who live closer to other centers.

Ultimately, the BAT Cave will help more people reclaim their lives: their ability to walk, speak and return home to their families.

Holmstedt puts it simply:

“The bottom line is, every single South Carolinian is going to benefit from this.”

Because when every minute counts, every investment moves us closer to a healthier South Carolina.