Comprehensive Stroke Center
UMMC Earns Prestigious National Stroke Distinction
As the first stroke center in Maryland dedicated to comprehensive care of patients with cerebrovascular disease, University of Maryland Medical Center’s latest accolade places it in an elite national group providing the most complex stroke treatment.
UMMC recently achieved the Joint Commission’s Advanced Certification as a Comprehensive Stroke Center, a new distinction earned by only about 70 stroke centers throughout the United States. An independent, not-for-profit organization and the nation’s oldest standards-setting body in healthcare, the Joint Commission evaluates and accredits more than 20,000 healthcare organizations and programs in the country.
About 700 patients suffering from all types of strokes — including ischemic stroke, intra-cerebral hemorrhage and subarachnoid hemorrhage — receive care at UMMC’s Stroke Center each year, according to Barney J. Stern, M.D., professor and interim chair of the Department of Neurology at University of Maryland School of Medicine and Director of the Comprehensive Stroke Center. These numbers include patients from the Baltimore area as well as those transferred from hospitals within the University of Maryland Medical System and other regional institutions.
“Our track record in terms of quality care, along with the provisions we’ve outlined for maintaining and further improving the quality of our care, were integral in allowing us to achieve the designation,” Dr. Stern explains. “In Maryland, we’re one of only two comprehensive stroke centers, so we stand out as being one of a very elite group of hospitals across the country.”
Broad-based Interdisciplinary Team for Ischemic Stroke Treatment
The UMMC Stroke Center’s Brain Attack Team, which handles the more common ischemic strokes, works closely with a broad-based interdisciplinary team that includes neurologists, emergency medicine physicians, neurosurgeons, neuroradiology interventionalists, neurocritical care specialists, vascular surgeons, stroke rehabilitation specialists, stroke nurses and other support staff to offer multi-modality treatments tailored to each patient’s specific case, Dr. Stern says.
“It sounds pedestrian,” he says, “but the most important thing that applies to all patients is very rigorous attention to their neurologic and general medical status, making sure they’re getting the proper level of care all the way from pre-hospital care to the Emergency Department, and from the Neurocare ICU to the step-down unit, and coupled with post-stroke rehabilitation.”
Typical treatments include the clot-busting drug tPA — which can be administered intravenously up to 4.5 hours after an ischemic stroke occurs — as well as catheter-guided arterial recanalization to clear blood vessels in the brain of oxygen-depriving clots. Modern recanalization techniques pull large clots from arteries using lattice-like mesh stents, replacing older hook-like snares that weren’t as effective, Dr. Stern says.
“Before the stent retrievers, these procedures took two to three hours. Now we’re able to potentially re-establish blood flow in about 30 minutes,” he says. “It’s a very impressive advance.”
‘Home Grown’ Stroke Research
Dr. Stern is excited about ongoing cutting-edge lab research that has defined a fundamental mechanism of brain swelling after large ischemic strokes and identified a promising drug to lessen the swelling. Led by professor of neurosurgery J. Marc Simard, M.D., Ph.D., the research has become part of a multi-center consortium of 12 hospitals hoping to enroll about 50 patients in a clinical trial.
Brain swelling, which can prove lethal, occurs in 60% to 80% of patients with very large middle cerebral artery territory strokes, Dr. Stern explains, and about 70,000 patients nationally are at risk for this type of stroke complication each year. The only currently recognized treatment is a surgical technique known as decompressive craniectomy, which removes part of the skull to allow swollen brain tissue to expand without being squeezed.
Dr. Simard’s research would allow patients with this swelling to potentially avoid surgery. The National Institute of Neurological Disorders and Stroke may become involved in a broader study of this approach, according to Dr. Stern.
“This is a true translational research endeavor that is home grown and holds considerable promise,” Dr. Stern says. “This drug-oriented approach is potentially safer and less invasive. The surgery reacts to the swelling, but the medication holds potential for preventing swelling in the first place.”