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Stroke Care

Why Choose Treatment for Stroke at University of Colorado Hospital?

Minutes matter when you're having a stroke - and so does expertise.

University of Colorado Hospital is a Joint Commission-certified Comprehensive Stroke Center. This means that we provide stroke victims the highest level of care possible.

We not only provide a level care not found elsewhere in the region, our 24/7 Stroke Alert System is designed to get that care to the patient as soon as possible before precious minutes slip away.

Why UCH?

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.

Our "Get with the Guidelines" Designation

Get With the Guidelines 2012 Gold Plus

The American Heart Association and American Stroke Association recognize this hospital for achieving 85% or higher adherence to all Get With the Guidelines® Stroke Performance Achievement indicators for consecutive 12 month intervals and 75% or higher compliance with 6 of 10 Get With the Guidelines Stroke Quality Measures to improve quality of patient care and outcomes in addition to achieving IV rt-PA door-to-needle times ≤60 minutes in 50% or more of applicable acute ischemic stroke patients (minimum of six) during one calendar quarter.

Medical Team

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 and Treatments

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 Perfusion
  • 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.

  • Intra-arterial (IA) treatments.

Depending on the location and severity of your stroke, you may need to undergo an emergency interventional procedure after you arrive at the hospital. These "intra-arterial" (IA) procedures – which are done inside arteries in your brain – are performed by specially trained interventional neuroradiologists.

 

During IA procedures, a long tube, or catheter, is inserted into a large artery in your groin and directed, via advanced imaging, through your blood vessels until it reaches the problem area in your brain. The physician injects a dye to highlight the blocked blood flow, and can either dissolve the clot by injecting tPA into it, or remove the clot with a tiny surgical device:

    • A "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.
    • The Penumbra Suction Catheter works like a vacuum, using suction to remove the clot.

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.

Patient Information Booklet: What to Know About TIA and Stroke

 

  • What is a transient ischemic attack (TIA)?
  • What is a stroke?
  • How is a TIA related to a stroke?
  • What are the risk factors and symptoms?
  • I think I might be having a stroke - what should I do?

View/download this free patient information booklet to get answers to these and other questions about TIA and stroke. Included in the booklet are sections for keeping track of doctors, medications, and other health information.

 

This booklet is also available in an online version.

Patient Education: See a Stroke Patient's Story

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.

 

Watch the video

 

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.

Stroke Survivors and Caregivers: Free LEAP Seminar Coming Soon

LEAP program logoYou are cordially invited to join us for four dynamic days of sharing, learning, and growing from your experience with stroke.

 

View/download the LEAP seminar flyer to learn more.

Additional Resources


Stroke Outcomes at UCH

Unruptured Cerebral Aneurysm Clipping & Coiling

A cerebral aneurysm describes a ballooning of a part of a blood vessel in the brain. The wall of this bulge is weak and at risk to rupture, leading to a subarachnoid hemorrhage, where blood will leak out of the ruptured vessel and into the space between the brain and the protective layers surrounding the brain. A ruptured aneurysm is a medical emergency and requires immediate medical intervention. However, the majority of brain aneurysms do not rupture, nor do they cause any symptoms. These unruptured cerebral aneurysms can be detected with imaging tests and may require treatment to prevent rupture.

 

There are two common interventional procedures for unruptured aneurysms, which your neurosurgeon may recommend based on the characteristics of the aneurysm.  Surgical clipping involves the placement of a small metal clip around the neck of the ballooning to cut off the blood supply to the unruptured aneurysm. During endovascular coiling, a wire is coiled up inside the unruptured aneurysm, which causes the blood to clot, also cutting off its blood supply.

 

Comparison. When compared to the national university hospital data, University of Colorado Hospital has not experienced any deaths during these surgical procedures throughout the past 4 years while treating over 250 patients. The national data reports an expected death rate during these procedures to be between 0.5 – 1.5% of patients.

Carotid Endarterectomy

A major source of ischemic stroke is the plaque, or buildup of fat and cholesterol, found within the carotid (kuh-ROT-id) arteries in your neck. If these large blood vessels are narrowed or blocked by this plaque, your brain can be deprived of its major oxygen and nutrient supply, which may cause a stroke. Some pieces of this plaque can also break off, travel into the brain, and cut off blood supply in a smaller vessel, again leading to a stroke.

 

If you are at risk for a stroke, or have already had one, you may be offered a Carotid Endarterectomy (END-ar-ter-EK-to-me) or a CEA in an effort to prevent future stroke. This is a surgical procedure that aims to remove the plaque buildup from a carotid artery in order to restore normal blood flow through that artery.

 

Comparison. When compared to the national university hospital data, University of Colorado Hospital has not experienced any deaths during these surgical procedures throughout the past 4 years while treating 49 patients. The national data reports an expected death rate during these procedures to be between 0.5 – 0.9% of patients.

Stroke Treatment with tPA (clot busting medication)

Target Stroke is a national quality improvement initiative sponsored by the American Heart and Stroke Association encouraging more efficient and timely emergency treatment of ischemic stroke. Currently, only the clot-busting medication called tPA is available and given to all patients that meet the criteria through their veins, or intravenously (IV). IV tPA is only effective when given shortly after stroke symptoms have started. Although there is a time window of four and a half hours from symptom onset to give IV tPA, the medication works the most effectively the earlier it is given during this time window.

 

IV tPA can prevent major disability after stroke. This campaign was created because nationally, the medication was only given to 1% of all ischemic stroke patients. There were 2 main reasons why this medication was underutilized. First, many patients could not get to the hospital within the strict time window. Second, hospitals were lacking an efficient system in regards to the evaluation for IV tPA. Currently, IV tPA is still only given to 3-8% of all ischemic stroke patients. However, the treatment rate at University of Colorado Hospital is currently above the national average at 24%. It is our goal to ensure any patient that qualifies for IV tPA receives it in a timely yet safe manner.

Time to Treatment for Ischemic (non-bleeding) Stroke

60 minutes or less. The goal of Target Stroke is for hospitals to treat at least 50% of their ischemic stroke patients who are receiving IV tPA within 60 minutes of arrival to the emergency department. This initiative aims to have IV tPA started earlier in order to maximize its benefits in preventing disability after stroke. A stroke patient is touched by at least 13 different healthcare providers, who all have specific roles in the evaluation of that patient, and need to coordinate with each other before a decision can be made about IV tPA. The goal is only at 50% as opposed to 100% because there are many times when it is not safe to start the medication before all of the necessary tests are interpreted, or a family member has not yet given consent. Target Stroke provides tools and guidelines to help hospitals start their own quality improvement project in the hopes of creating a more efficient system that can easily meet these goals.

 

University of Colorado Hospital (UCH) took on the Target Stroke initiative with great enthusiasm. This quality improvement project led to many structural and cultural changes in our system involving the evaluation and treatment of emergency stroke patients. Within 6 months of rolling out our new and improved system, we were able to surpass the goals of Target Stroke. We are currently treating over 68% of our stroke patients receiving IV tPA within an hour of arrival. When a hospital can consistently meet this goal, they are awarded the status of the Target Stroke Honor Roll. UCH has been on the Honor Roll since 2011. If you are interested in learning more about Target Stroke and the Honor Roll, please visit this website:

 

http://www.strokeassociation.org/STROKEORG/Professionals/Target-Stroke-Honor-Roll-Sites_UCM_318484_Article.jsp

 

Another goal of UCH involves progressively lowering our average time of starting IV tPA. Instead of sticking to the national 60-minute goal, we want to aim lower. Our 2012 median was 43 minutes. As we continue to work on improving our system, we will also continue to set more difficult goals. University of Colorado Hospital embraces the culture of quality improvement, which keeps our focus on building an even better future rather than settling for the goals we have already met in the present.

Time to Treatment for Interventional Radiology (IR) Cases

At UCH, our goal is to begin all IR cases within 90 minutes of arrival to the hospital. Our year-to-date median time for beginning cases falls exactly at our goal of 90 minutes.

 

After the Target: Stroke quality improvement project was successfully executed at UCH, a similar project was undertaken for our emergent IR cases. Now that we have met our treatment time goals, it is time to aim higher (or lower, if you think in terms of treating faster)! An interdisciplinary team meets regularly to review all previous treatment cases and look for ways to improve for each patient. At UCH, we are committed to continual improvement in order to provide exceptional patient care.


Cranium - side view image

Strokes: at a Glance

Strokes occur when blood vessels to the brain are blocked (ischemic stroke) or burst (hemorrhagic stroke). This prevents oxygen from reaching the brain and damage can begin within minutes. The parts of the body controlled by that part of the brain will not work properly.

That is why it is important to know the signs of stroke and to act fast. Minutes matter when the very first stroke symptoms appear. Call 911 immediately!

Stroke Warning Signs

  • Sudden numbness or weakness in the face, arms or legs – especially on one side of the body
  • Sudden confusion or trouble speaking or understanding speech
  • Sudden vision trouble in on or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

Stroke Statistics

The statistics for stroke are startling:

  • Stroke is the 4th leading cause death in the U.S.
  • It is the #1 cause of permanent disability – 3 million Americans cannot work because of stroke
  • 731,000 strokes occur annually
  • The ideal treatment window for most strokes is within 3 hours
  • Only 3 – 5% of patients make it to the hospital in time for treatment
  • Most people don’t know the signs of stroke
  • A recent survey showed that people fear having a stroke more than dying because of the disability they may have

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Brain and Nerve Specialties

An A to Z list of information on conditions, symptoms, tests, treatments, clinical tests and new findings by type.

Events

  • BLS for the Healthcare Provider
  • AWHONN Advanced Fetal Monitoring Course

    The Advanced Fetal Heart Monitoring course is designed for Registered Nurses and Physicians with the goal of building on basic knowledge of essential principles of fetal monitoring including the current NICHD terminology and categories. The focus is on advanced concepts relating to assessment, interpretation, management and evaluation of fetal heart rate patterns, using case scenarios for illustration and reinforcement. This course is open to UCH employees and Family Medicine MD's and other qualified providers affiliated with UCH only.

  • Oncology PCT Updates - Intake & Output: Why it's Important