Components of the Spokane Stroke Program
Sacred Heart’s Emergency services staff works with community EMS and the Northwest MedStar air ambulance team to provide rapid transport, emergency assessment and intervention. However, treatment must begin within three hours from the onset of stroke symptoms for IV treatment to be effective. Intra-arterial treatment must begin within six hours of the onset of stroke symptoms.
Neurologists are an integral part of the stroke team. Their expertise is crucial from the moment the patient enters the Emergency Department through hospitalization and rehabilitation of the patient. They assist the referring physician to navigate the stroke patient through the new stroke algorithms, depending on the nature of the stroke. Treatment options include emergent intravenous or intra-arterial thrombolysis, anticoagulation or use of neuroprotective agents.
Specially trained neuroradiologists work closely with neurologists and neurosurgeons who specialize in stroke. These physicians evaluate and treat stroke patients with the most advanced therapies, including:
- Intra-arterial thrombolysis: a procedure that utilizes special micro catheters enabling clot-dissolving medication to be delivered at or near the clot, opening acutely occluded intracranial vessels to restore blood flow.
- GDC coils: small coils that are endovascularly introduced via small catheters into the cerebral arteries to occlude or close off aneurysms without surgery.
- Cerebral angioplasty: a procedure similar to coronary angioplasty where small balloons are used to dilate delicate intracranial arteries that are in spasm after subarachnoid hemorrhage.
- Intraoperative angiography: a powerful technique providing surgeons with immediate feedback of crucial information during the actual clipping of an aneurysm or an arteriovenous malformation.
- Endovascular stenting: a procedure that bypasses stenotic or partially occluded vessels without craniotomy.
Cerebrovascular neurosurgeons provide state-of-the-art surgical techniques in treating stroke, including:
- Aneurysm clipping and reconstruction to exclude an aneurysm from circulation while maintaining normal cerebral blood flow.
- Brain mapping to identify eloquent speech and motor areas during resection of arteriovenous malformations.
- Cerebral revascularization to graft blood vessels, restoring blood flow to areas of the brain deprived of blood and re-routing blood flow around arteries that may need to be occluded during aneurysm treatment.
- Stereotactic radiosurgery to non-invasively radiate arteriovenous malformation using a device called the X-Knife.
Advanced Diagnostic Imaging
Technically sophisticated imaging capabilities are available to thoroughly assess a patient’s stroke risk or to identify the type and impact of stroke.
- Computed tomography (CT, CAT) scanning is available in several forms. Dynamic infusion CT scanning can identify blood vessels. Rapid spiral scan is a faster technology with improved diagnostic quality.
- Magnetic resonance imaging assists in identifying early stroke as well as the region of the brain at risk. This study is helpful to differentiate whether the patient is having the warning signs of stroke or “true” stroke.
- Magnetic resonance angiography is a non-invasive test that screens for vascular lesions. It is especially useful for patients who may be allergic to contrast media.
- Single photon emission computerized tomography (SPECT) radionuclide scanning is a physiologic exam to evaluate cerebral blood flow for signs if ischemia.
- Cerebral angiography is the “gold standard” in identifying arteriovenous malformation, occlusion, stenosis, aneurysm, dissecting vessels and other abnormalities in the cerebral blood vessels.
- Carotid artery duplex Doppler and color flow Doppler are non-invasive exams to locate carotid artery narrowing or stenosis in the neck.
- Transcranial Doppler detects cerebral vasospasm that can occur after subarachnoid hemorrhage. Vasospasm can lead to stroke. This modality can also evaluate intracranial carotid narrowing or stenosis.
Providence Sacred Heart Medical Center’s lab is nationally recognized for its state-of-the-art technology and clinical expertise. Complete hematologic, coagulation and stat stroke panels are prioritized for the treatment of stroke. Lipid evaluation is available for identification of lipid disorders associated with stroke.
Patients suffer disability, but the degree of disability depends on the size and location of the stroke. Research has shown that a majority of stroke patients demonstrate improved long-term outcomes if inpatient rehabilitation begins within hours after the onset of stroke symptoms.
Most of the improvement after strokes occurs within three to six months of rehabilitation, and most patients make continued but slower improvement over a longer period. Rehabilitation is a challenge for the patient and family. It is important that the patient and family work together with the rehabilitation.
At the Providence Neuroscience Center, intensive therapy is provided by speech pathologists, dietitians, physical therapists, nurses, case managers and physiatrists. Outpatient rehabilitation is coordinated with St. Luke’s Rehabilitation Institute or with local therapists in the patient’s home community. The team of specialists develops an individualized course of treatment for each patient. Support groups, educational services and individual counseling are also available. When patients return home, rehabilitation therapies continue through outpatient therapy programs.
Research and Education
Providence Sacred Heart’s Medical Research Center is committed to being a leader in neuroscience care. Clinical research studies are ongoing to investigate treatment methods that prevent nervous system and cardiovascular damage. Drug trials with neuroprotective agents are ongoing, as are other neurologic research projects that may help limit the devastating and often deadly results of stroke.