radiology

The Comprehensive Stroke Center at University    Hospital

Expertise and Outcomes

 

University Hospital participates in Get With The Guidelines® - Stroke, a hospital-based program of the American Heart Association/American Stroke Association for improving stroke care by promoting consistent adherence to the latest scientific treatment guidelines.  In 2019 for the seventh year in a row, University Hospital received recognition for Gold Plus Achievement for successfully meeting or exceeding research-based standards for the diagnosis and treatment of stroke patients.

To achieve "Gold Plus" recognition, a hospital must achieve 85 percent or higher adherence for at least two consecutive years on all achievement measures and 75 percent or higher adherence on five or more select quality measures during a 12-month period.

GWTG-Stroke's Target: StrokeSM Honor Roll award recognizes hospitals that rapidly treat ischemic stroke patients with the critical clot-busting drug tPA (tissue plasminogen activator).  Most ischemic strokes are caused by the blockage of a brain artery by a clot and tPA can be given intravenously to break up the clot and restore normal blood flow to the brain.  To be effective, tPA must be administered within 4.5 hours of the onset of stroke symptoms; and the sooner it is administered, the more effective this treatment is in achieving excellent outcomes, defined as patients experiencing mild or no disability at 90 days from the stroke.  Once a patient arrives in the hospital, tPA should be given within 60 minutes of arrival.

University Hospital was recognized in 2019 with the Target: Stroke Elite award for administering tPA to eligible stroke patients within an hour of arrival at the hospital at least 75% of the time during a 12-month period.  In 2018 we administered tPA within 60 minutes of hospital arrival to 89% of eligible patients, with an average time of 51 minutes from hospital to arrival to tPA administration.

For certain patients, physical removal of the blood clot causing the stroke becomes necessary.  As a Comprehensive Stroke Center, trained doctors (endovascular surgeons) are available 24/7 to thread a catheter through an artery in the groin up to the blocked artery in the brain, allowing the direct removal of the clot either by infusing tPA in close proximity to the clot, or by mechanical means.  This procedure is generally done within less than 6 hours after the start of stroke symptoms.  At University Hospital we have a high success rate with mechanical endovascular reperfusion.  In 2018 our specialists were able to remove the clot and re-establish substantial blood flow 84% of the time that mechanical endovascular reperfusion therapy was performed on eligible ischemic stroke patients.  In the first quarter of 2019, substantial blood flow was re-established 96% of the time.

Opening a blood vessel with intravenous tPA or by catheter based reperfusion carries a small risk of hemorrhage with worsening of the stroke (symptomatic hemorrhage).  According to the original large study which led to the approval by the FDA for the use of IV tPA for acute stroke, the symptomatic hemorrhage rate for IV tPA treatment should be less than 6.2% per year.  In each of the last five years, our symptomatic hemorrhage rate, whether patients were treated with  intravenous tPA, catheter-based reperfusion, or both, ranged from 0% to 3.8%.

bar chart

 

It is critical that the public becomes familiar with the signs and symptoms of stroke, and that someone calls 9-1-1 immediately.  University Hospital has extensive experience in treating stroke patients with removing clots safely. The number of catheter based endovascular reperfusion procedures we do is growing.  In 2016 we treated 23 patients with this procedure; in 2017 the number was 33, and in 2018 it was 36 patients.  Just in the first quarter of 2019 we treated 24 patients – therefore we may treat 100 patients this year.

bar chart

 

Other Early Treatments for Stroke

University Hospital's team of experts includes surgeons who specialize in stroke treatment. Procedures include:

  • Carotid Artery surgery or stents
  • Cerebral Aneurysm surgery
  • Treatment of Arteriovenous Malformations (AVM)
  • Surgery to relieve pressure on the brain from very large ischemic or hemorrhagic strokes

 

All data presented on this website is University Hospital's independent analysis of data gathered using the Get With The Guidelines Patient Management ToolTM. It is not an analysis of the national Get With The Guidelines dataset and does not represent findings from the AHA Get With The Guidelines National Program.