Surviving a stroke: Why access to a comprehensive stroke center matters
Timing is everything when it comes to stroke survival. Here’s what’s unique about a comprehensive stroke center, from cerebrovascular surgery options to neurocritical care.
When someone experiences a stroke, time is of the essence to remove the blockage and restore blood flow to the brain. These life-saving efforts can preserve tissue and prevent damage. That’s why it matters if a patient is taken for emergency stroke treatment.
“Every minute that clicks by, approximately 1.8 million neurons, or brain cells, die while the artery remains occluded,” said Michael Froehler, M.D., Ph.D., a stroke surgeon and neurologist with Vanderbilt Neurosciences. “So every minute truly does count.”
Because of this, it’s crucial that those who are at an increased risk for stroke know where the nearest comprehensive stroke center is located in their region. Often, patients end up at hospitals that do not have the capabilities to provide the full array of stroke treatment options. They then must be transferred to a comprehensive stroke center that does.
Froehler led a recent study that looked at transfer time and the impact it has on patient outcomes. “What we found is that the length of time lost because of transfer between hospitals approaches two hours — more than an hour and a half,” he said. “That results in significantly fewer good outcomes compared to patients who present directly to comprehensive stroke centers.”
How do you find a comprehensive stroke center?
The Joint Commission accredits hospitals with this designation if the facility meets a set of minimum criteria for treating stroke. Vanderbilt University Medical Center is a designated Advanced Certification Comprehensive Stroke Center, the Commission’s highest achievable certification. “Vanderbilt is really the most extensive in terms of its medical coverage of any of the comprehensive stroke centers that I’m familiar with,” Froehler said. “Not only do we provide advanced treatments and therapies, but we’re also actively engaged in clinical trials and provide the cutting edge of medical therapy for patients with cerebrovascular disease.”
What happens when a patient arrives?
As soon as the Vanderbilt medical team suspects a stroke, the first responders will alert the stroke team before the patient even comes through the doors. Once you arrive, a “code stroke” is activated. “This all happens in a matter of minutes,” Froehler said. “We do a whole set of very rapid tests to determine if the patient is indeed having a stroke, if there is blockage of an artery, whether they are a candidate for the clot-busting medication called tPA, and whether or not they’re a candidate for a catheter-based treatment to remove a larger blood clot.”
What are the next steps for stroke treatment?
The next step in treatment for ischemic stroke is reperfusion, which means restoring blood flow to the brain. “And again it’s all about time,” Froehler said. “It’s important to mobilize the stroke team and get things done as fast as possible.”
That’s followed by a stay in the neurocritical care unit, where the patient is monitored and treated, if necessary, for brain swelling. Patients who have hemorrhagic stroke are treated through a variety of intensive-care techniques, he said.
“There’s also the important task of investigating the cause of the stroke so that we can prevent the patient from having another stroke,” he said. A narrowing of the carotid artery, for example, may require stenting to keep it open.
What happens when a patient is discharged?
Once a patient is stable and ready to be discharged from the hospital, the next step is often rehab. “That’s one of the important things that we arrange while the patient is here,” Froehler said. “And we’ll continue to follow up with stroke patients in our clinic to ensure that we’re doing everything we can to prevent future stroke and to help with the rehabilitation process.”
This means coordinating treatment with the patient’s primary care physician to address stroke risk factors, such as high blood pressure, diabetes, high cholesterol and smoking. Many patients also require extended heart monitoring to look for an abnormal rhythm that can increase stroke risk.