Stroke Care

Stroke is caused by a lack of oxygenated blood making it into the brain. This can be caused by blood clotting in the brain which deprives it of oxygen or by a burst blood vessel. In either case, care is needed immediately if the victim is to survive without permanent damage.

Ischemic Stroke (blocking)

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• This type of stroke occurs when the blood flow in an artery of the brain is blocked by a blood clot or plaque buildup and the brain tissue dies.
• This is the most common type of stroke accounting for approximately 87%.

Hemorrhagic Stroke (bleeding)

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• This type of stroke occurs when a weakened blood vessel in the brain bursts or leaks causing bleeding.
• It is typically caused by high blood pressure or an aneurysm.
• It is less common, but more likely to be fatal.

The most important way to survive a stroke is to get help quickly. A stroke usually happens suddenly and can cause problems with moving, feeling, speaking, or seeing. Sometimes, a stroke that causes bleeding in the brain can lead to a very bad headache that starts right away.

To remember the signs of a stroke, think BE FAST.

• B – Balance: Is the person suddenly dizzy or having trouble walking?
• E – Eyes: Is the person having trouble seeing?
• F – Face: Does one side of the face droop?
• A – Arms: Is one arm weak or numb?
• S – Speech: Is speech slurred or hard to understand?
• T – Time: If you see any of these signs, it’s time to call 9-1-1 right away!

Getting help fast can save a life and prevent serious problems.

What you CANNOT control

What you CAN control

Age: every 10 years you live, your risk of stroke increases Gender: Women have more strokes than men Race: African Americans have a higher risk of stroke than any other race. Past stroke or TIA: People who have had a stroke or TIA have a higher risk for stroke. Family history: Risk of stroke is higher when heart attack, stroke, or TIA runs in the family. Atrial fibrillation (Afib): Afib is the common type of irregular heartbeat. It can cause blood to pool, forming a clot that could travel to the brain causing a stroke.

High blood pressure: Control your blood pressure to reduce stroke risk. High cholesterol: LDL > 70mg/dL increases risk of stroke. Smoking: Stop smoking, vaping, or using tobacco products. They increase the risk of stroke. Alcohol use: Limit alcohol intake to 1 drink/day for women; 2 drinks/day for men. Diabetes: A1C > 5.6% increases risk of stroke Obesity: Exercising 20-30min/day 5x/week Nutrition: Eating a well-balanced diet such as the Mediterranean Diet can help reduce risk of stroke. Taking your medicines as your doctor prescribed

CSTK-1: NIHSS in 12 hours

• All ischemic stroke patients will have an NIH Stroke Scale documented prior to any intervention or within 12hrs of arrival.

STK-1: DVT Prophylaxis

• Ischemic and hemorrhagic stroke patients must receive VTE prophylaxis the day of or day after admission
• Rationale: stroke patients are at an increased risk of developing a DVT as opposed to other patients. A DVT (Deep Vein Thrombosis) is a blood clot.

STK-2: Antithrombotics prescribed at discharge

• Ischemic stroke patients must be discharged on an antithrombotic or if the patient is ineligible for antithrombotic therapy, a reason must be documented why.
• Rationale: data suggests that patients who take daily antithrombotic after a stroke reduce morbidity and mortality.

STK-3: Anticoagulation for patients diagnosed with A-fib or A-flutter

• Ischemic stroke patients must be discharged on anticoagulant if presents with afib/aflutter
• Rationale: these are risk factors for stroke. Prescribing an anticoagulant at discharge helps prevent recurrence of stroke. If the patient is ineligible for anticoagulation therapy, a reason must be documented why.

STK-4: Initiation of IV lytic (clot buster) within 3.5 hours of “last seen well” for eligible patients

• IV lytic must be given within the applicable timeframe (if indicated)
• Rationale: IV lytic administration in eligible patients is most effective if used within three hours of symptom onset. IV lytic is a medication that helps break up the clot to restore blood flow to the brain.

STK-5: Antithrombotic therapy started at the end of hospital day no. 2

• Antithrombotics must be given by the end of hospital day 2 or documented contraindication provided
• Rationale: studies show that administering an antithrombotic within two days of stroke reduces morbidity and mortality.

STK-6: Patients should have an LDL level drawn within 48 hours of admission. Patients with LDL >100 should be discharged home on Statin therapy

• LDL level must be drawn for all strokes within 48 hours of arrival
• Rationale: Patients with LDL > 100 mg/dL should be prescribed a Statin at discharge to reduce the recurrence of stroke. High cholesterol is a risk factor for stroke.

STK-8: Patients or family members must be provided with stroke education.

• Stroke education
• Rationale: Patients with strokes must be educated on risk factors, activation of EMS, the importance of follow-up after discharge, medications they have been prescribed, and warning symptoms/signs of stroke. Early activation of EMS and proper treatment of stroke significantly increases life spans of patients with stroke. Appropriate education is imperative to the reduction of morbidity and mortality.

STK-10: Rehab must be considered for all patients

• Patient must be assessed for rehab services
• Rationale: two-thirds of people that suffer strokes every year survive, leaving approximately 40% with some form of functional impairment. These patients require some form of rehab.

National Benchmark Goal is 90%

Median number of minutes from time of arrival at EJGH to start of treatment with clot busting medication:

Percentage of patients with significant bleeding in the brain following treatment with clot busting medication:

Median number of minutes from time of arrival at EJGH to start of treatment with thrombectomy:

Percentage of patients with significant bleeding in the brain following a thrombectomy procedure:

Neuroendovascular coiling of aneurysms

This procedure is used to treat aneurysms that may cause hemorrhagic strokes. During the procedure, the doctor inserts a catheter into a blood vessel located in the groin or in the wrist. The catheter is advanced through the blood vessels into the brain where the aneurysm is located. The physician will use the catheter to place many tiny metal coils inside the aneurysm. The goal is to fill the aneurysm completely full of coils so it will not rupture and bleed. This procedure does not require open surgery into the brain.

Microsurgical neurovascular clipping of aneurysms

This procedure is an open surgery to treat aneurysms that cause hemorrhagic strokes. A neurosurgeon creates an opening into the skull to access the brain where the aneurysm is located. The surgeon then places a small metal clip on the blood vessel at the place where the aneurysm has formed. This permanently cuts off the blood flow into the aneurysm. The metal clip remains inside the brain after surgery.

Thrombolytic therapy ("clot busters")

Powerful medications, called thrombolytics, are used to treat ischemic strokes by breaking up clots to get blood flowing again in that part of the brain. The medicine may or may not completely break up the clot or clots. The sooner these medications get to work, the more brain tissue may be preserved, and less long-term damage may occur. They can only be given within a short window of time after a person first notices symptoms.

Thrombectomy

This procedure is used in the treatment of ischemic strokes. During the procedure, the doctor inserts a catheter into a blood vessel located in the groin or in the wrist. The catheter is advanced through blood vessels into the brain where the doctor will try to remove a blood clot located in a large vessel in either in your neck and/or head to improve blood flow to your brain.

Diagnostic Cerebral Angiogram

This is a minimally invasive surgery that uses catheters (endovascular) to inject die into the vessels in the brain to see any possible aneurysms, blockages, or narrow areas that may limit blood flow.

Carotid Endarterectomy (CEA)

This is a surgical procedure to remove the plaque—a hard, sticky buildup inside the carotid artery that can block blood flow to the brain— After the plaque is taken out, the artery is closed using stitches or a small patch to help it heal.

This surgery helps lower the risk of stroke by making it easier for blood to flow to the brain.

Carotid Artery Stent (CAS)

This is a minimally invasive surgery that involves placing a small mental coil (stent) into a narrowed section of the carotid artery to help improve blood flow and reduce the risk of stroke.

Transcarotid Artery Revascularization (TCAR)

This is a minimally invasive surgery that uses surgical balloons and small metal coils (stents) to reopen a clogged or narrowed carotid artery to help improve blood flow and reduce the risk of stroke.

External Ventricular Drain (EVD)

Your brain makes a special liquid called cerebrospinal fluid (CSF), which helps protect it. But sometimes, too much of this fluid builds up, and that can cause pressure inside the head. To fix this, doctors carefully place a small tube into the brain to let the extra fluid drain out into a bag outside the body. This helps keep the pressure in the brain at a safe level and can also remove infected fluid if needed

Diagnostic Cerebral Angiogram

Percentage of patients who experienced stroke or death within 24hrs of the procedure:

Aneurysm Procedures

Clipping/Coiling Mortality Rate:

EVD Infection Rates

We monitor all patients that have an EVD placed for CSF infections related to placement of the drain.

Asymptomatic Carotid Procedures

Percentage of patients who did not have symptoms prior to their procedure and experienced stroke or death in the 30 days following their CEA/CAS/TCAR:

Symptomatic Carotid Procedures

Percentage of patients who did have symptoms prior to their procedure and experienced stroke or death in the 30 days following their CEA/CAS/TCAR:

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