As a Joint Commission-designated Primary Stroke Center, The Valley Hospital has a rapid response protocol in place to swiftly triage, diagnose, and treat patients with stroke symptoms. Starting with our Mobile Intensive Care Unit paramedics and our Emergency Department (ED) staff, our stroke response team collaborates and coordinates all stroke services so that patients receive prompt care upon their arrival at the hospital, whether by ambulance or car. Our stroke response team includes an ED physician, neurologist, registered nurse, CT scan technologist, and patient care associate. They are in the hospital at all times.
Rapid Initiation of Tests
Following activation of the stroke response team in the ED, a patient with stroke symptoms undergoes a set of standard tests so that an ED physician can determine quickly whether a patient is experiencing a stroke and which type of stroke it is (embolic/ischemic or hemorrhagic). These tests include:
- an assessment of vital signs,
- medical history,
- laboratory tests,
- CT scan,
- fingerstick glucose test,
- speech and swallowing evaluation,
- complete neurological assessments by ED physician and neurologist.
tPA and Other Interventions for Embolic/Ischemic Stroke
Patients who come to the ED within three to four and one-half hours of the onset of stroke symptoms and are diagnosed with an embolic/ischemic stroke (blood clot blocking oxygen to the brain) are evaluated for treatment with tPA and/or neurointerventional treatments. tPA (tissue plasminogen activator) is a medication that is given intravenously or administered directly inside an artery to break up the blood clot. tPA is only given to adult stroke patients.
Treatment may also include an endovascular procedure called mechanical thrombectomy. In this procedure, trained doctors try removing a large blood clot by sending a wired-caged device called a stent retriever to the site of the blocked blood vessel in the brain. To remove the brain clot, doctors thread a catheter through an artery in the groin up to the blocked artery in the brain. The stent opens and grabs the clot, allowing doctors to remove the stent with the trapped clot. Special suction tubes may also be used. The procedure should be done within six hours of acute stroke symptoms, and only after a patient receives tPA.
If the time at which a patient’s symptoms began occurs outside the timeframe for tPA treatment but within a period of up to eight hours, the patient is evaluated for other minimally invasive neurointerventional treatments that take place inside the affected blood vessel (endovascular) and do not require brain surgery. Patients are treated inside Valley’s state-of-the-art neurointerventional and biplane suite, which is one of only a few in New Jersey.
Treatment for Hemorrhagic Strokes
Hemorrhagic strokes can occur if a blood vessel ruptures (often due to uncontrolled high blood pressure) or if a blood vessel balloons (aneurysm) or ruptures within the brain and blood leaks into the brain. When a hemorrhagic stroke is diagnosed in the ED, a neurosurgeon is notified and the patient undergoes a CT scan and cerebral angiogram (imaging test). Treatment may include:
- microvascular clipping to cut off the flow of blood to the aneurysm, deflate the aneurysm, and repair the blood vessel
- coil procedure, during which slivers of metal are delivered to the aneurysm via a catheter and placed inside the aneurysm to block blood flow
If the stroke occurs as a result of a rupture of an arteriovenous malformation (AVM), a tangle of faulty arteries inside the brain, treatment may include neurosurgery or a neurointerventional procedure that uses a glue-like substance to block blood flow from the AVM into the brain.
If a patient does not quality for any of the aforementioned treatments and/or has come to the ED outside of the eight-hour window, the patient will undergo appropriate testing, a neurological assessment, and may be treated with aspirin, cholesterol-lowering medications, anticoagulants (blood thinners), or other medications.
Neuroscience Intensive Care Unit
Following stroke treatment, patients are cared for and monitored in our Neuro ICU, a specialized inpatient unit staffed by neurologists, neurosurgeons, advanced practice neurological nurses, and registered nurses, all of whom are trained in critical care, advanced life support, and advanced cardiac life support. Many of our nurses have also attained national certification in critical care or neurological nursing.
Our stroke response team and other staff who regularly care for patients with stroke must complete four to eight hours of continuing stroke education every year. Valley’s Stroke Committee meets every month.