Rapid Stroke Treatment

GW Hospital Comprehensive Stroke Center

A stroke occurs when a blockage in an artery prevents blood from reaching cells in the brain or an artery ruptures inside/outside the brain, causing a hemorrhage. Each year more than 795,000 Americans suffer a stroke, causing one out of every 20 deaths in this country, according to the Centers for Disease Control and Prevention. Not only is stroke the third-leading cause of death in the U.S., it is also the leading cause of adult disability.

Stroke should be treated with the same urgency as a heart attack. The video below describes stroke warning signs and how the team at GW Hospital cares for stroke patients.

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Treating Stroke at GW Hospital

Medical professionals at the Comprehensive Stroke Center at GW Hospital provide fast and efficient stroke care to help patients reach a better outcome after suffering a stroke emergency. They are recognized as leaders in stroke care through their efforts in promoting stroke prevention and practicing quality stroke treatment.

Learn more about the Neurosciences Institute at GW Hospital >

In addition, the Acute Rehabilitation Team at GW Hospital offers stroke rehabilitation services to help patients on their path to recovery after a stroke.

Ischemic Stroke

Ischemic strokes account for 80 percent of all strokes suffered. They are caused when blood vessels become clogged. Some ischemic strokes are preceded by stroke-like symptoms called transient ischemic attacks (TIAs) that can occur months before the stroke. Also called a warning stroke, a TIA is caused by a temporary blockage of a blood vessel. TIA symptoms, which are similar to those of a stroke, come on quickly and improve within 10 to 20 minutes. The loss of vision in a TIA may be described as a feeling that a shade is being pulled down over your eyes. TIAs typically do not cause long-lasting damage to the brain. 

The clot-dissolving medicine called tissue Plasminogen Activator (tPA) is the drug of choice for ischemic stroke. If an ischemic stroke is diagnosed within three hours of the start of symptoms, the administration of tPA intravenously can increase a patient's chances of survival and recovery. Knowing stroke warning signs and getting to a hospital quickly is critical for tPA treatment to be successful. 

If a tPA infusion does not work, tPA and other clot dissolving agents can be delivered directly to the area of blockage using an angiogram. During this process, a catheter and X-ray guidance are used to take images of the blood vessels in the neck and brain. The blockage can also potentially be removed with fine-grasping instruments or the blocked vessel can be re-opened with stents.

First in The District with RAPID CT Perfusion Software

The RAPID CT Perfusion software is a class of automated brain imaging software that enables doctors to quickly visualize reductions in blood flow to the brain and early signs of brain injury. GW Hospital is the first in the District to have this software.

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Ischemic Stroke Volumes and Performance

2016-2017 Stroke Volumes

  Patient Type   # of Admission
  Ischemic Stroke:   336
  Intracerebral Hemorrhage:   95
  Subarachnoid Hemorrhage:   34
  Transient Ischemic Attack:   89

GW Hospital Performance Measures (2017)

  Stroke Performance Measures   Compliance Rate *
  Venous Thromboembolism Prophylaxis During the Hospital Stay:    97.7%
  Antithrombotic Prescribed at Discharge:    98.6%
  Anticoagulant Prescribed at Discharge for Afib:    97.3%
  tPA Given within 3 Hours of Onset of Stroke:    100%
  Antithrombotic Prescribed by Day 2 of Hospital Stay:    96.8%
  Statin Medication Prescribed at Time of Discharge:    99.0%
  Stroke Education Performed:    94.3%
  Assessed for Rehabilitation:    98.4%

* National Target Rate is greater than 90% Compliance.

Joint Commission Comprehensive Measure:

GW Hospital is proud to perform discharge follow-up with more than 90 percent of its stroke patients 90 days after they leave the hospital. This metric is better than the national average when compared with other academic hospitals.

Acute Ischemic Stroke Treatment

  • 2016 GW Outcomes: 97 percent of our patients were free of symptomatic hemorrhage after treatment with Alteplase in 2016
  • 2016 GW Outcomes: 96 percent of our patients were free of symptomatic hemorrhage after treatment with Alteplase and/or endovascular treatment (clot extraction and/or intraarterial Alteplase)
  • 2016 GW Outcomes: We treated a total of 75 patients with Alteplase and/or endovascular treatment (clot extraction and/or intraarterial Alteplase)

Hemorrhagic Stroke

Fewer strokes are categorized as hemorrhagic, which occur when weakened blood vessels inside the brain rupture (such as a tangle of defective blood vessels and capillaries called arteriovenous malformations (AVMs)) or when an aneurysm (a thin spot on an artery wall) at the base of the brain bursts. Every year, an estimated 30,000 people in the United States experience a ruptured cerebral aneurysm according to the American Association of Neurological Surgeons. 

Symptoms more specific to hemorrhagic stroke include headache, nausea and vomiting, neck stiffness, seizures, sudden changes in mental state and lethargy. Hemorrhagic strokes usually occur in the daytime and during physical activity. The symptoms typically begin very suddenly and evolve over several hours. 

Initial treatment of a hemorrhagic stroke is difficult. Efforts are made to control bleeding, reduce pressure in the brain and stabilize vital signs, especially blood pressure. There are few medications available to treat hemorrhagic stroke. The Comprehensive Stroke Center at GW Hospital offers hemorrhagic stroke patients with options including surgery, endovascular treatment and diagnostic neuroangiography. 

Surgical Treatment 

Surgery can be used if a large amount of bleeding has occurred and the patient is rapidly getting worse. Depending on the location of the aneurysm and a patient's condition following the stroke, surgery may not be an option. Surgery can involve clipping the aneurysm, surgical resection of AVMs and carotid endarterectomies.

Surgical Clipping

Treats an aneurysm by placing a clip across its neck or origin to prevent filling of the aneurysm.

  • 2016 GW Outcomes: 100 percent of our patients were stroke, re-intervention, re-bleeding and mortality free.

Surgical Resection of AVMs

Prevents further bleeding by removing the tangle of defective blood vessels and capillaries.

  • 2016 GW Outcomes: Patients who have undergone this treatment modality were 100 percent stroke and mortality free.

Carotid Endarterectomy

Opens a carotid artery blockage and cleans out the debris narrowing of the vessel.

  • 2016 GW Outcomes: 95 percent of our patients were stroke and re-intervention free within 30 days. Mortality rate was 0 percent.

Endovascular Treatment 

Another option is sealing the aneurysm with coils delivered through the angiogram technique. This is the less invasive option, but is not yet suitable for all aneurysms. Methods include:

Endovascular Coiling

Treats an aneurysm by packing the weakened area of the ballooning vessel with small coils that fill the space and prevent bleeding.

  • 2016 GW Outcomes: 97.1 percent of our patients were stroke and mortality free within 24 hours after procedure.
  • 2016 GW Outcomes: 100 percent of our patients that have undergone elective aneurysm coilings and clippings were stroke and mortality free within 24 hours of procedure.

Endovascular Embolization of AVM

Injects a small amount of glue-like material that seals off the abnormal connection between vessels.

  • 2016 GW Outcomes: Patients that received treatment for an AVM were 100 percent stroke and mortality free within 30 days of procedure.

Endovascular Stenting of Carotid Artery Occlusions

Uses a metal mesh tube to re-establish normal blood flow to the brain and is deployed through a catheter.

  • 2016 GW Outcomes: Among patients who underwent carotid stenting or carotid angioplasty, 93 percent were stroke free and 100 percent were re-intervention free within 30 days after procedure. Mortality rate was 7 percent.

Diagnostic Neuroangiography 

An advanced imaging technique where an interventional radiologist accesses neck and brain vessels through an artery in the groin. This diagnostic technique allows precise mapping of brain arteries and problem areas.

  • 2016 GW Outcomes: We performed 216 diagnostic cerebral angiograms that were stroke and mortality free within 24 hours.

Awards and Accreditation

 
TJC Seal

GW Hospital is designated a Comprehensive Stroke Center by The Joint Commission and American Heart Association. 

 

2018 Get With the Guidelines - Target: Stroke Honor Roll Elite Plus Gold Plus

The George Washington University Hospital has received the Get With The Guidelines SM–Stroke (GWTG–Stroke) Gold Plus Quality Achievement Award with Target: Stroke Elite Plus from the American Heart Association and American Stroke Association for implementing a higher standard of stroke care. This is the highest recognition possible in this category and recognizes our commitment to improving patient care and outcomes.

 

Learn more about GW Hospital's achievements>

Additional Resources 

Take Our Brief Stroke Risk Assessment.

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Podcast: Stroke: F.A.S.T. Action Could Save a Life 

Kathleen Burger, DO, discusses risk factors for the two major types of stroke (ischemic and hemorrhagic), including high blood pressure, high cholesterol, diabetes, sedentary lifestyle, obesity, and smoking.

Listen to the podcast  

Podcast: Stroke Care: Treatment and Technology Update

Dimitri Sigounas, MD, discusses the new technologies surrounding stroke recognition and treatment, including the future development of portable devices that could assess stroke type and severity before the patient even arrives at the hospital.

Listen to the podcast