Rapid Stroke Treatment

 

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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.

Medical professionals at the Comprehensive Stroke Center at the George Washington University 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 the George Washington University Hospital offers stroke rehabilitation services to help patients on their path to recovery after a stroke. 

Stoke 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. Learn more about stroke and how to reduce your risk >

Begin Assessment   Take our brief Stroke Risk Assessment.

Treating Stroke at GW Hospital 

Ischemic Stroke

Accounts for eighty 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 is 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.

Ischemic Stroke Volumes and Performance

2015 Stroke Volumes

  Patient Type   # of Admission
  Ischemic Stroke:   289
  Intracerebral Hemorrhage:   80
  Subarachnoid Hemorrhage:   41
  Transient Ischemic Attack:   111

GW Hospital National Performance Measures: (Data from Q3 2014 - Q2 2015)

  Stroke Performance Measures   Compliance Rate *
  Venous Thromboembolism Prophylaxis During the Hospital Stay:    96.8%
  Antithrombotic Prescribed at Discharge:    99.6%
  Anticoagulant Prescribed at Discharge for Afib:    97.1%
  tPA Given within 3 Hours of Onset of Stroke:    100%
  Antithrombotic Prescribed by Day 2 of Hospital Stay:    95.9%
  Statin Medication Prescribed at Time of Discharge:    98%
  Stroke Education Performed:    98.9%
  Assessed for Rehabilitation:    97.4%

* National Target Rate is greater than 85% Compliance.

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The George Washington University Hospital achieves between 90 and 100 percent compliance with all measures.

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The George Washington University Hospital has a less-than-2-percent complication rate from tPA.

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

  • GW Outcomes: 100% of our patients were stroke, re-intervention, re-bleeding and mortality free in Q1 2015 - Q3 2015.

Surgical resection of AVMs prevent further bleeding by removing the tangle of defective blood vessels and capillaries 

  • GW Outcomes: Patients who have undergone this treatment modality were 100% stroke and mortality free in Q1 2015 - Q3 2015.

Carotid endarterectomies open a carotid artery blockage and clean out the debris narrowing of the vessel

  • GW Outcomes: 100% of our patients were stroke and re-intervention free in Q1 2015 - Q3 2015. Mortality rate is 1.2%

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.

The treatment of brain aneurysms, AVM’s and carotid artery blockage through a catheter that’s inserted into the arteries. 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

  • GW Outcomes: In Q1 2015 - Q3 2015, 100% of our patients were stroke and mortality free within 24 hours after procedure

Endovascular embolization of AVM injects a small amount of glue-like material that seals off the abnormal connection between vessels

  • GW Outcomes: In Q1 2015 - Q3 2015, patients that received treatment for an AVM were 100% 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

  • GW Outcomes: In Q1 2015 - Q3 2015, among patients that have undergone carotid stenting or carotid angioplasty, 100% were stroke free and 100% were re-intervention free within 30 days after procedure.

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.

  • GW Outcomes: Q1 2015 – Q3 2015, there were 194 diagnostic cerebral angiograms performed that were stroke and mortality free within 24 hours.

Stroke Awards and Accreditation 

 

TJC Seal

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

 

 


 

Gold Plus

The George Washington University Hospital has received the Get With The Guidelines SM–Stroke (GWTG–Stroke) Gold Plus Award with Target Stroke Honor Roll from the American Heart Association and American Stroke Association for implementing a higher standard of stroke care. 

 

 

Learn more about GW Hospital's achievements>