Stroke Care

Our stroke team mobilizes quickly

Time is of the essence from the first moments stroke symptoms appear.

Within minutes, UCH's Stroke Alert system mobilizes a comprehensive team of specialists at any time, night or day, that assesses and cares for the stroke patient the minute he/she comes through our door.

Superior Expertise in Stroke Care

University of Colorado Hospital has the largest neurovascular service in the state. Our nationally renowned doctors offer highly specialized surgical techniques and interventional neuroradiology procedures not available elsewhere in Colorado. This means better results for patients who may otherwise suffer from irreversible brain damage or death.

Though time is one of the biggest factors in achieving better outcomes, thanks to the level of expertise found at UCH, the window of opportunity for intervention may be extended.

Full Service Stroke Care

Once the patient passes through the initial crisis stage, the hard work of recovery begins.

Neuro Intensive Care Unit. The patient first goes to the Neuro ICU as the medical treatment and further evaluations progress.

Stroke Unit. The patient then moves to the Stroke Unit within our Neurosciences department to complete medical evaluation and begin the recovery process.

Rehabilitation. Our physiatrist works the patient through intense therapies to help him/her prepare to go home as soon as possible.

Follow-up. Although patients leave our hospital, they never truly leave our care. With neurologists specializing in the care of stroke patients, medical management continues after discharge and staff in the Neuroscience Center make follow up calls throughout that first year after the patient returns home.

Stroke Specialists: Acute Care

The care given at the time of a stroke can mean the difference between a good outcome and a bad outcome – and sometimes even between life and death.

Stroke is a medical emergency and care begins with the arrival of the EMS team. This team is specially trained in the stabilization of a patient and emergency transport. It is the first step in stroke care. If their local hospital cannot provide stroke services, a patient can be transferred to University Of Colorado Hospital and that patient may be cared for by our critical care EMS team, specially trained to care for stroke patients in transit.

Once at University Of Colorado Hospital, a Stroke team responds to begin the process of diagnosis and treatment of the patient. Our team is comprised of the following healthcare experts:

• Emergency physicians and nurses – continue stabilization and continue diagnostic work up
• Stroke nurse practitioner – directs care of the patient, including treatment decisions
• Neurosurgeon – a surgeon specializing in the surgery of nervous system structures. In the case of a stroke victim, the surgery is used to treat hemorrhages and aneurysms.
• Neurologist – a medical doctor that diagnoses and treats medical (non-surgical) disorders of the nervous system
• Hospitalist – a medical doctor based in the hospital specializing in the care of patients admitted to the hospital
• Interventional radiologist – A radiologist who specializes in the use of imaging (CT, fluoroscopy, ultrasound) to perform procedures. When treating a stroke victim, this specialist's goal is to clear blood vessel blockages.
• CT/MRI staff – specialists who take radiographic  images to identify the source of the neurologic deficit
• Neuroradiologists – specialists using x-rays, CT and MRI images to diagnose disorders and diseases of the nervous system
• Intensivist – a physician who specializes in the care and treatment of  patients requiring critical care for their diagnosis
• Neurological ICU and neuroscience unit nurses – provide continued care to patients after admission, working to prevent complications and preparing patients for rehabilitation
• Social workers – work with patients and families to provide support during hospitalization for what is often a life-changing event. They work to coordinate after-care services as well as to provide psychosocial support to the family
• Discharge planners – work with patient and family to facilitate discharge to the most appropriate setting, whether that’s rehabilitation here at University of Colorado Hospital, a rehabilitation hospital closer to their home, a skilled nursing facility or to outpatient therapy services

Stroke Specialists: Rehabilitation

Once the acute phase of stroke care is completed, the rehabilitation phase begins. This phase can last weeks to months, sometimes as long as a year or more. This care team specializes in helping patients recover function, retrain the body and show patients how to adapt to their deficits.

This team is comprised of the following specialists:

• Physiatrist – a physician who is trained in rehabilitation medicine, who leads the team of specialists providing rehabilitation care
• Physical Therapists – provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease
• Occupational Therapists – help people improve their ability to perform tasks in their daily living and working environments
• Speech/Language Pathologists – sometimes called speech therapists, assess, diagnose, treat, and help to prevent speech, language, cognitive-communication, voice, swallowing, fluency, and other related disorders
• Dieticians – Dietitians and nutritionists plan food and nutrition programs and supervise the preparation and serving of meals. They help to prevent and treat illnesses by promoting healthy eating habits and recommending dietary modifications, such as the use of less salt for those with high blood pressure or the reduction of fat and sugar intake for those who are overweight
• Social workers – work with patients and families to provide support during rehabilitation for what is often a life-changing event. They work to coordinate after care services as well as provide psychosocial support to the family.
• Discharge planners – work with patient and family to facilitate return to home or the most appropriate setting

Tests for Stroke

There are no blood tests currently that can tell us if a person is having a stroke. We must rely on images taken of the brain, using either MRI or CT technology.

Commonly used diagnosis imaging tests:

• MRI
• CT
• CT Profusion
• CT Angiography

CT perfusion and CT angiography allow physicians to look at areas that aren’t getting enough blood (ischemic) and look for blockages in blood vessels in the brain. These scans are obtained almost immediately upon arrival to the hospital, and allow the physicians time to evaluate the patient and make decisions about treatment options.

Treatments for Stroke

The treatments for stroke are limited. Currently we can use:

• Drugs that will “dissolve” the clot in an artery

Alteplase (tPA^©) is the drug most commonly used to break up blood clots in the brain. It can be used up to 3 hours from symptom onset when given through an IV. When given via intra-arterial approach, Alteplase can be given far longer after symptom onset. Many facilities are not capable of using the intra-arterial approach. At University Of Colorado Hospital we have treated stroke as far out as 24 hours after symptom onset with this method.

• A corkscrew-like device that removes a clot from an artery.

The corkscrew known as the Merci^® retrieval device (Mechanical embolectomy)  is used to “capture” blood clots in blood vessels in the brain. It can be used up to 8 hours from symptom onset.

Stroke Prevention

Stroke prevention is still the best medicine! The most important treatable conditions linked to stroke are:

• High blood pressure. Treat it.
• Cigarette smoking. Quit.
• Heart disease. Manage it.
• Diabetes. Control it.
• Transient ischemic attacks (TIAs) (stroke systems appear for a short time and then disappear). Seek help.

When a blockage is detected, surgical and non-surgical techniques can be used to treat it and to prevent a future blockage:

Non-Surgical options for Cerebrovascular Disease

Anticoagulants/Antiplatelets are medications that help prevent clots.

Surgical options for Cerebrovascular Disease

Some diagnostic and surgical techniques require highly specialized skills which few facilities offer. University of Colorado Hospital's expert medical team offers the broadest range of treatment options in the region.

Treatments for narrow or blocked arteries

• Carotid endarterectomy – this surgical procedure is done by a specially trained neurosurgeon who removes the plaque that is narrowing or blocking an artery.
• External Carotid/Internal Carotid Artery Bypass – Similar to the idea of heart bypass, the neurosurgeon uses a branch of the external carotid artery (which supplies blood to the scalp and face) and connects the artery past the blockage to the internal carotid. This surgery resupplies blood to the brain for the clogged artery.

Treatments for hemorrhages/aneurysms

• Clip ligation (“clipping”) – this surgical procedure is done by a specially trained neurosurgeon who strategically places a “clip” at the base of the aneurysm.
• Aneurysm coiling – Coiling is a minimally invasive procedure is done by an interventional radiologist. The aneurysm is treated from within the blood vessel by placing a “coil” to block the blood flow.

Rural hospitals may not have the ability to provide accurate diagnosis and treatment for stroke. It is always appropriate to request a transfer to a facility such as UCH capable of delivering higher level stroke services. Remember, minutes matter when it comes to stroke treatment!

Life After a Stroke

Adjustments that need to be made after having a stroke will greatly depend on the amount of damage or “deficit” a patient is left with, which is dependent on whether or not they got treatment in time. Deficits will range from minor things such as numbness or tingling in a hand or weakness in an extremity when tired, to major deficits such as paralysis of one side of the body and the inability to speak or understand language.

After stroke, rehabilitation will play a large role in whether or not a person can return home to independent living or will require assistance. Rehabilitation may occur in an inpatient rehabilitation hospital immediately after stroke, continuing as an outpatient once a patient’s functional level improves enough to leave the hospital setting.

Other priorities after stroke include the prevention of future strokes and optimizing health by reducing risk factors, such as quitting smoking, decreasing cholesterol, increasing activity and adding exercise to your daily routine. Control of risk factors greatly reduces the risk of having another stroke and ending up with additional neurologic deficits or worsening of the deficits from the first stroke. Working with your doctor or nurse practitioner, you can develop a plan that will minimize your overall risk and help you to improve your health.

Stroke: Getting a Second Opinion

While not always possible during the acute phase of the stroke, a second opinion is always applicable if additional non-emergency treatments are needed or when making the transition to rehabilitation.

• American Stroke Association
• National Stroke Association
• Easter Seals Disability Service
• Rocky Mountain Stroke Association
• Colorado Stroke Alliance
• The Impact of Heart Disease and Stroke in Colorado: A Report from the Colorado Department of Public Health ad Environment