Diagnosing and Treating Stroke

When you have a stroke, every minute counts
The stroke program at Hoag offers a rapid response stroke team comprised of emergency room physicians, neurologists, neurosurgeons, neuroradiologists, critical care physicians, specialty-trained nurses and other critical support staff. The hospital’s on-site neurology hospitalists and interventional neuroradiologists offer patients an even higher level of specialized care.

The stroke team quickly evaluates and treats patients utilizing the latest in leading-edge diagnostic, treatment and interventional techniques. The sooner patients receive appropriate stroke treatment, the better their chances for survival, and for suffering the least amount of permanent damage and disability.

Equipped with state-of-the-art diagnostic imaging technologies, Hoag physicians are able to quickly assess stroke and determine the best possible treatment for stroke patients. Sophisticated brain imaging provides detailed pictures of affected areas including cerebral structures and blood flow. These images allow Hoag clinicians to diagnose and treat stroke within minutes, and with greater precision, resulting in improved patient outcomes.

The stroke team utilizes Hoag’s highly advanced multi-detector 64-slice CT as well as Hoag’s state-of-the-art 3Tesla MRI scanners, which provide exquisite detail of subtle brain function and structure using vascular, anatomic and physiologic imaging, displaying these in three dimensions. Angiography and ultrasound are also used to detect blocked blood vessels and areas where the brain is affected, as well as to guide treatment.

Endovascular Intervention

As a leader in acute stroke care, Hoag provides a full range of minimally invasive endovascular techniques for both the prevention and treatment of stroke. Early detection of stroke risk includes the use of ultrasound to look for silent blockage in the arteries leading to the brain.

Carotid stenting is a preventive procedure for certain high-risk patients with such blockages, where post balloon angioplasty, a sleeve made of fine metal mesh, or stent, is fitted inside the newly opened carotid artery in order to hold the artery open and restore blood flow to the brain.

Hoag also specializes in preventive treatment of potentially explosive weak spots in the arteries of the brain. Such weak spots, or aneurysms, can be found on CT or MRI scans. Endovascular coiling or injection of other substances may be a treatment option for patients with hemorrhagic stroke—the type of stroke caused by bleeding in the brain either due to an aneurysm or other blood vessel malformations.

Innovative Ischemic Stroke Treatment

More than 80% of all acute strokes are caused by blood clots. One treatment option for stroke is Tissue Plasminogen Activator (tPA), a medication that helps dissolve blood clots. To be effective, tPA must be administered within 4.5 hours from the onset of symptoms or Last Known well time. And since the average patient is brought to the emergency room between three and six hours after the onset of symptoms, intravenous tPA is administered to approximately two percent of patients nationwide. That’s why it’s so important for individuals to seek immediate emergency treatment at the first sign of stroke.

For strokes caused by an occlusion in the large arteries in the brain, mechanical removal or thrombectomy of the clot can be performed up to 24 hours from when the patient was Last Seen Normal (without stroke symptoms) if the patient meets criteria for this.

Mechanical clot retrieval devices include stent retrievers and suction devices.

A wire-cage device called a stent retriever can also be used. The catheter is threaded through an artery in the groin up to the blocked artery in the brain.

The stent opens and grabs the clot.

The Penumbra system is comprised of a catheter, separator and suction device. In the treatment of acute ischemic stroke, a catheter is guided to the site of the blood clot while the separator, fed through the catheter, continuously breaks up the clot while the aspiration pump vacuums the clot debris from the blocked vessel.

Armed with these devices and an extended treatment window, Hoag Hospital neuro interventionalists are successfully helping a broadened patient population to improve neurologic recovery and reduce the incidence of disability resulting from acute ischemic stroke.

Stroke Rehabilitation

A key to recovering from a stroke is physical, occupational, speech, and cognitive rehabilitation. Hoag’s Fudge Family Acute Rehabilitation Center provides the newest and most advanced post-stroke in-house rehabilitation unit in Southern California, with expert physicians, therapists, and specially trained nurses.