Expertise and Outcomes
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 2022 for the tenth 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 reach an aggressive goal of treating patients with 85 percent or higher to core standard level of care as outlined by American Herat Association/American Stroke Association for 2 consecutive calendar years. In addition, hospital must demonstrate 75 percent compliance to four out of seven quality measure or higher adherence on five or more select stroke 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 2022 with the Target: Stroke Elite award for administering tPA to eligible stroke patients within 60 minutes of arrival at the hospital at least 85% of the time during a 12-month period. In 2021 and into the first half of 2022, we exceeded this target, and we increased the percentage of patients who were given tPA within 30 minutes:
In 2021, our average administration time was 43.9 minutes. In the first half of 2022. the average time was only 31.3 minutes which has significantly improved from the previous year 2021.
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 can be done up to 24 hours from the time the patient is known to be normal or at baseline function. At University Hospital we have a high success rate with mechanical endovascular reperfusion. In 2021 and 2022 January to June our specialists were able to remove the clot and re-establish substantial blood flow 88% of the time that mechanical endovascular reperfusion therapy was performed on eligible ischemic stroke patients.
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 four years, our symptomatic hemorrhage rate and or other complications, whether patients were treated with intravenous tPA, catheter-based reperfusion, or both, ranged from 0% to 3.8%.
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 has increased over the past few years. In 2018 we treated 36 patients with this procedure; in 2019 the number was 70, and in 2020 it was 100 patients. In 2021 we treated 76 patients.
Data based on discharge date
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