Anyone who has had a loved one suffer from a stroke knows how devastating it can be. They also know that getting good medical care quickly is essential. Fortunately for everyone, stroke treatment has advanced at an astonishing rate over the last decade, allowing more hospitals to treat stroke patients well and to establish themselves as stroke centers.
However, “Not all strokes and therefore, not all stroke centers are created equal,” says Dr. Dorothea Altschul, Neuro-interventionalist and Clinical Director of Neurosciences at St. Joseph’s Regional Medical Center. “Depending on the type of stroke, where you get treatment becomes very important. Some stroke centers are not equipped to deal with the more complicated cases.” For this reason, Dr. Altschul is among a growing number of specialists who believe that stroke centers need to be rated using higher standards to differentiate the level of care they provide.
Strokes are divided into two types generally, they are either ischemic or hemorrhagic. An ischemic stroke is caused by a blood clot that blocks blood flow in the brain and a hemorrhagic stroke is caused by bleeding in the brain.
Patients who suffer from an ischemic stroke can be treated the most widely because of a drug called Tissue Plasminogen Activator (TPA). TPA can dissolve blood clots and is routinely used in emergency rooms across the country with great success.
This drug has some limitations, however. It must be used within the first three hours of symptom onset and it can’t always tackle the larger blood clots. Only facilities with specialized equipment and the right doctors are able to provide the care needed when TPA isn’t enough. If that patient is lucky enough to be at the right location they can have the stroke-causing blood clot removed from their brain with a minimally invasive procedure carried out by a specially trained neurosurgeon or neuro-interventionalist.
Patients who suffer from the other kind of stroke (the hemorrhagic one) are even more in need of these kinds of medical facilities and specialists because their treatment is even more complicated. They cannot be treated with TPA because there is no clot to dissolve. In their case, the source of the bleeding, often a ruptured cerebral aneurysm, needs to be stopped.
A cerebral aneurysm occurs in the brain when the wall of a blood vessel becomes weakened and balloons out. These “balloons” carry a high risk of bursting since their walls are so thin. When they do, surgeons can now go in and place a clip at the base of the aneurysm to stop the bleeding. Brain surgery like this and the procedure described earlier to remove the blood clot needs to be done by a neurosurgeon or a neuro-interventionalist, like Dr. Altschul, who has access to the right equipment and a specialized neuro-intensive care unit.
So, how do you know what kind of stroke your loved one is having? You don’t. This can only be determined by medical professionals. Then, how do you know the best place to take them? If you live in New Jersey you may find yourself overwhelmed by the number of specialized stroke centers that have proliferated across the state. To help remedy this situation, satisfaction and patient outcome rating systems have been established by a number of independent companies like Healthgrades. These grades, often read as a number of stars given, can be found on medical facility websites or, as a recent article on the New Jersey news site nj.com points out, ratings can be found on the dozens of stroke center billboards that have sprouted up across the state.
In their article titled, State’s top neurologists suggest higher standards for comprehensive stroke centers, Dr. Altschul is among a handful of stroke experts to weigh-in on the issue of stroke center ratings.
According to the nj.com article, “The proliferation of comprehensive centers…has many neurologists calling for higher standards so patients can better identify which hospitals are best qualified to handle the most complex cases.” They mention too that politicians like State Sen. Barbara Buono (D-Middlesex) have gotten involved in pushing for legislation that requires the Department of Health to distinguish stroke centers more rigorously than they are now and they say, “The [New Jersey] state Department of Health is considering those recommendations.”
In the meantime, find out if the hospital or stroke center nearest you has a neuro-intensive care team that includes a neurosurgeon or a neuro-interventionalist. We are happy to recommend The Valley Hospital and St. Joseph’s Regional Medical Center as just such places.
