MD News ? Exceptional Regional Stroke Care - Health Topics

By: Staff Writer Thursday, June 23, 2011

Stroke is the third-leading cause of death in the United States and the leading cause of disability, according to the American Stroke Association. At Shands at the University of Florida?s Comprehensive Stroke Program, patients have access to state-of-the-art technology and an experienced medical team of UF physicians who routinely collaborate to optimize the best possible outcome.

Photo: Anna Khanna, M.D., and Michael Waters, M.D., Ph.D.

The region?s only stroke program that provides comprehensive care 24 hours a day, seven days a week, Shands at the University of Florida?s Comprehensive Stroke Program is the only center in North Central Florida to receive accreditation from both The Joint Commission on Accreditation of Healthcare Organizations and the Agency for Health Care Administration. following guidelines set forth by the American Heart Association, the American Stroke Association, the Brain Attack Coalition and The Joint Commission, emphasis is placed on both treating acute stroke and reducing future stroke risk.

Shands at UF?s Comprehensive Stroke Program has an experienced team of UF stroke and vascular neurologists and neurosurgeons, as well as a 30-private bed neuro intensive care unit staffed by critical care nurses who are specially trained and experienced in caring for stroke patients. A helicopter transport program is also in place to provide expedient transfer for patients throughout the region.

?Shands at UF?s Comprehensive Stroke Program is one of the largest stroke programs in the state of Florida dedicated to leading-edge, endovascular care for treatment of acute stroke,? says Brian Hoh, M.D., UF neurosurgeon. ?We have 24/7 coverage available 365 days a year, and our helicopter pad allows for patients throughout the region to receive enhanced access to leading-edge endovascular treatments.?

Multidisciplinary Care

Emphasizing a team approach, UF neurosurgeons, vascular neurologists, neuroradiologists, vascular surgeons, critical care physicians and rehabilitation specialists work together to ensure patients receive the best possible care. from the moment patients enter the emergency department to the time they are discharged following rehabilitation, physicians work together to develop treatment plans that will help patients regain optimal function and quality of life following a stroke.

?Utilizing a multidisciplinary approach to care enhances our ability to treat patients who have had an acute stroke,? says AnnaKhanna, M.D., UF neurologist. ?By working together and using state-of-the-art treatment and rehabilitative modalities, we are able to reduce morbidity and mortality, ensuring that patients benefit from a quicker return home after suffering a stroke.?

Providing Expedient Care when Time Matters Most

As soon as emergency medical technicians arrive on scene to assist a patient who is having a stroke, they alert a stroke medical team consisting of neurologists and residents trained in recognizing and treating the signs and symptoms of stroke, which allows physicians to prepare for the patient?s arrival in the emergency department. Once the patient arrives in the ED, stroke neurologists and emergency medicine physicians collaborate to evaluate the patient as quickly as possible. At this time, several imaging studies will be done.

?Every acute stroke patient who presents in the ED benefits from a stroke imaging protocol that consists of a noncontrast CT scan, followed by a CT angiogram and a CT perfusion scan,? says Dr. Khanna. ?The noncontrast CT scan and CT angiogram give us the opportunity to examine the intracranial and extracranial vessels, which allows us to best determine how to proceed with treatment. The CT perfusion scan determines whether the patient has decreased blood flow to the penumbra. This is the most important part of our imaging protocol, as our techniques are not as aggressive if the penumbra cannot be saved.?

?As a neurosurgeon, I routinely review images with our stroke neurologists and analyze what blood vessels are blocked and what parts of the brain are at risk for further damage due to lack of blood and oxygen,? adds Dr. Hoh. ?Based on those findings, we decide what treatment a patient should have. if a patient arrives within four hours of the onset of symptoms, intravenous tissue plasma activator [tPA] may be administered. if that is ineffective or if the four-hour window has expired, several other leading-edge modalities may be administered.?

Following emergency treatment of stroke, patients are admitted to the Shands at UF neuro intensive care unit. This 30 private-bed unit is designed to provide enhanced monitoring and nursing care for critically ill patients who have experienced brain disease or injury. All neuro intensive care unit rooms are private and include specialized equipment used to monitor patients? brain activity and vital signs 24/7. Staff also has access to brain-pressure monitoring and electroencephalogram monitoring, as well as a CT scanner that is installed adjacent to the neuro intensive care unit, allowing timely access to imaging modalities necessary to examine blood flow and the extent of blockages in the brain and neck.

State-of-the-Art Technology

If IV tPA is ineffective at dissolving the responsible blood clot and restoring blood flow, intra-arterial thrombolysis may be used. other possible treatment modalities available include use of microsuction devices, including the Penumbra System and the Merci Retrieval System, which are both able to remove blood clots from blood vessels in the brain. Angioplasty, stenting and hemicraniectomy round out the possible treatment options by UF physicians at Shands.

The Penumbra System, which is manufactured by Penumbra, inc., consists of a microcatheter that is navigated through the groin into the blocked blood vessel in the brain through use of X-ray guidance. A suction device is then used to remove the blockage responsible for stroke.

The Merci Retrieval System is similar to the Penumbra System and also provides a minimally invasive method to remove blood clots responsible for stroke. This device is threaded and navigated from the groin into the brain using X-ray guidance. A corkscrew-like device is then employed to secure the blood clot and remove it from the body.

If minimally invasive treatment modalities are ineffective at restoring blood flow or if intracranial edema has developed, UF vascular neurosurgeons ? among them Dr. Hoh and J Mocco, M.D., M.S. ? are also skilled in performing hemicraniectomy.

Helping Patients Regain Normal Function ?Following Stroke

At Shands Rehab Hospital in Gainesville, FL, patients have access to quality inpatient and outpatient rehabilitative care.

Shands Rehab Hospital is one of only 10 centers in the state designated as a brain and spinal cord rehabilitation center through the Florida Brain and Spinal Cord Injury Program. It also has received accreditation through The Joint Commission and has been designated as a comprehensive, inpatient facility for adult medical rehabilitation through the Commission on Accreditation of Rehabilitation Facilities. More than 1,800 stroke patients have received care at Shands Rehab Hospital, and points of emphasis for care include physical and occupational therapy, speech and language pathology, and psychological and recreational therapy.

A Resource for Area Hospitals and Physicians

To help enhance stroke care for patients throughout North Central Florida, Shands at UF?s Comprehensive Stroke Program has established protocols and educational programs for regional physicians in the area of education regarding stroke care, transportation and treatment. through a partnership between UF physicians, the ShandsCair Critical Care Conference and the ShandsCair Flight Program, education ? including prehospital care protocols ? has been provided, as well as implementation of a stroke alert system for all patients who present with stroke symptoms. when a stroke alert is activated, the stroke team at Shands at UF?s Comprehensive Stroke Program assembles, and flight transport is arranged for patients at surrounding facilities.

To learn more about the services provided through Shands at UF?s Comprehensive Stroke Program, visit shands.org.

MD News May/June 2011, North Central Florida

Tags: Anna Khanna, Brain Attack Coalition, responsible blood clot, Following Stroke At Shands Rehab Hospital, acute stroke, american heart association, Joint Commission
This entry was posted on Tuesday, June 28th, 2011 at 7:35 pm and is filed under Speech Pathology. You can follow any comments to this entry through the RSS 2.0 feed. You can skip to the end and leave a comment. Pinging is currently not allowed.

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