Every year in the United States more than 790,000 people suffer a stroke. Stroke can affect people of all ages, race, or ethnicity and is currently the leading cause of serious, long term disability. The devastating impact of stroke shows that more than 40% of all new stroke diagnosis patients experience moderate to severe disability that will require specialized care that can place families in a financial crisis as they attempt to meet the needs of their loved ones. Recent estimates project that total health care costs related to stroke exceed $43 billion per year.
When a stroke occurs, every minute the brain is deprived of oxygen leads to potentially irreversible brain damage. Early intervention is the key to successful stroke treatment and must be administered rapidly following the onset of symptoms, which is better defined as the time the person was “last known normal.” Symptoms of stroke include facial droop, numbness or weakness of the face, arm or leg, loss of speech or slurring of words, and sudden headache with no known cause. Unfortunately, recent literature suggests that 40% or more of all Americans over the age of 50 cannot state the warning signs of stroke or the importance of early 911 activation for immediate transport to a specialized hospital that can diagnose and treat both hemorrhagic (bleeding) and ischemic (clot) stroke.
The Comprehensive Stroke Center at St. Joseph’s Hospital was one of the first in the State of Florida to achieve this designation by the Florida Agency for Health Care Administration (AHCA) in 2007. In addition, The Joint Commission has continuously recertified St. Joseph’s Hospital as a Primary Stroke Center of excellence since its initial certification in 2006.
The “Don’t Wait or Hesitate” philosophy guides stroke care at St. Joseph’s Hospital, where a team of specialized nurses work closely with highly skilled emergency room physicians, neurologists, neurosurgeons, neuro interventionists and interventional radiologists to efficiently coordinate high-quality, patient-centered care – any time of day or night. The stroke team activates immediately upon arrival of a stroke alert, obtaining all relevant patient history, performing the NIH Stroke Scale and instituting a rapid triage process to ensure the timely acquisition of diagnostic testing. The implementation of established evidence-based treatment protocols begin with state-of-the art Computed Tomography (CT) scans that include angiography and perfusion studies, when appropriate, to initiate all available stroke interventions. This revolutionary concept is applied to the hospitalized patient as well.
The newest diagnostic tool at St. Joseph’s Hospital, called Non-Invasive Optimal Vessel Analysis (NOVA), is not available anywhere else in the state of Florida. NOVA Magnetic Resonance Angiography (MRA) is innovative technology that provides a numerical evaluation of blood flow in the brain to all major cerebral vessels without an invasive test. This is important information when trying to determine a patient’s chance of having a stroke.
Once the diagnostic testing has been completed and resulted (within 45 minutes of arrival), a diagnosis is interpreted as hemorrhagic or ischemic stroke. An appropriate treatment strategy is then developed, individualized to the acute stroke patient. In the past, a patient suffering from a stroke was treated conservatively with only supportive care as the mainstay of therapy. Now, if there is no bleeding in the brain and the patient meets the inclusion and exclusion criteria, a powerful blood clot dissolving medication (tissue plasminogen activator, or t-PA) is administered into a vein that has been demonstrated to improve the outcome of stroke patients if given within 3 hours of initial onset, and in some cases, up to 4.5 hours of initial onset.
As a lead provider of innovative stroke treatment options in the Tampa Bay community, the Comprehensive Stroke Center at St. Joseph’s Hospital provides multiple endovascular therapies for ischemic stroke, which account for approximately 85% of all stroke diagnosis. Endovascular treatment of ischemic stroke is performed in a dedicated Siemens Artis ZEE biplane angiography suite, which can extend the time window for effective treatment to 6-8 hours from stroke onset and, in some unique cases, this window of opportunity can be extended up to 12 hours. An endovascular mechanical clot retrieving device for acute ischemic stroke has been available at St. Joseph’s Hospital since obtaining FDA approval in 2004. In addition, our expert physicians have several mechanical clot retrieval devices available such a Stryker TREVO Provue, Covidien Solitaire device, Concentric MERCI retriever and Penumbra system to further enhance recovery from an ischemic stroke. These devices can be utilized in combination with t-PA or when intravenous t-PA is ineffective in reversing the effects of an acute ischemic stroke.
It is estimated that the remaining 15% of all strokes are due to the effects of hypertension that damage cerebral blood vessels and cause bleeding into the brain tissue called an intracerebral hemorrhage (ICH). Another cause of bleeding in the brain can be the result of a ruptured brain aneurysm. A percentage of these patients die before ever reaching the hospital or will suffer from some form of permanent neurological impairment. Brain aneurysms, like ischemic stroke, can occur in people of all ages but usually go undetected until symptoms develop or the aneurysm ruptures. Treatment for brain aneurysms have benefited significantly over the last 10 years in part because of the advanced imaging capabilities at St. Joseph’s Hospital, which can determine the size, location, and ability to treat the aneurysm without undergoing an invasive craniotomy. With this information, I can access the femoral artery and treat the cerebral aneurysm, whether or not it is ruptured , with the most advanced technology, such as Cordis Orbit Galaxy/Galaxy 2 or Micrus Presidio/Microsphere endovascular coils that permanently seal or “fill” the inside of the cerebral aneurysm. In some cases, the EV3 Pipeline stent can be deployed to treat a cerebral aneurysm that was not amendable to coil embolization or to ensure complete closure of the cerebral aneurysm neck.
In addition to the advanced stroke therapies offered at St. Joseph’s Hospital Comprehensive Stroke Center, other neuro interventional services include arteriovenous malformations (AVM) utilizing EV3 Onyx embolization liquid embolic system, carotid stenting with Cortis Enterprise and Angioguard system, cerebral vasospasm therapy, intracranial angioplasty, or treatment of head and neck tumors.
Because time is brain when it comes to stroke, St. Joseph’s Hospital Comprehensive Stroke Center developed a one-call patient access center. By calling 813-870-4945, advanced treatment options for both the ischemic and hemorrhagic stroke patients can be activated at a moment’s notice. This unmatched service has positioned St. Joseph’s Hospital as a hub for specialized stroke intervention by an experienced and skilled physician network.
St. Joseph’s Hospital Comprehensive Stroke Center has received the American Heart Association/American Stroke Association’s “Get With The Guidelines” Gold Plus award 3 years in a row for maintaining strict compliance with their quality measures, which are dedicated to the diagnosis, treatment, and prevention of stroke.
“We are proud of our achievements and commitment to our community by providing the highest quality care and state-of-the-art treatment to our stroke patients and families” said Pamela D’Amore, administrative director of St. Joseph’s Hospital’s Heart Institute and Neuroscience Program. “Our stroke program has a long history of providing outstanding treatment, management and prevention services of stroke and transient ischemic attack. Our main objective is to improve quality of life within our community.”
Neuro Interventional Radiologist: Dr. Matthew Berlet:
Dr. Berlet serves as the Medical Director of the Department of Radiology and as Medical Director of the Stroke Program at St. Joseph’s Hospital in Tampa. He is a Board-Certified Radiologist with a subspecialty expertise in neuro radiology. After completing his undergraduate degree at Bucknell University, Dr. Berlet attended The University of Medicine and Dentistry in New Jersey where he attained his Medical Degree. He completed his Internship at Hackensack Medical Center in New Jersey before completing his Residency Program at the New England Deaconess Hospital (Beth Israel Deaconess Hospital). His Fellowship Program was completed at Massachusetts General Hospital.
By Matthew Berlet, MD