Ischemic Stroke

Ischemic Stroke Overview

An ischemic stroke occurs when a blood vessel to the brain is blocked by a clot. As a result, part of the brain cannot get blood and oxygen and begins to die. There are two types of stroke, ischemic and hemorrhagic, which results from bleeding in the brain.

Stroke, which is sometimes called “brain attack,” is the fifth most common cause of death for Americans and is the leading cause of adult disability. Stroke is more common in women than in men. Each year 800,000 Americans will suffer a stroke and 130,000 will die as a result.

Thrombotic: a clot develops in an artery that supplies blood to the brain.
Embolic: a clot develops elsewhere and is transported by the blood to a narrow brain artery. This is often caused by an irregular heartbeat, which can lead to pooling and clotting of blood in the heart.

Wellstar physicians are experts at diagnosing and treating Ischemic and Hemorrhagic stroke.

Wellstar Kennestone Regional Medical Center located in Marietta offers a full service Neuroscience program for stroke and other neurological emergencies. Wellstar Kennestone is one of the few comprehensive cerebrovascular neurosurgery programs in the region, offering state-of-the-art procedures for both open and closed vascular and endovascular procedures for stroke and carotid artery disease. Wellstar Kennestone is proud to offer the highest level of specialized care in order to meet the needs of our region and beyond. In addition, Wellstar Kennestone offers a CARF certified in-patient Rehabilitation program on campus.

A key component adding to the breadth of the stroke program at Wellstar Kennestone is active participation in clinical research trials. While always adhering to best practice and gold standards of care, clinical trials allow our highly trained physicians to better the care of our stroke patients and collaborate with highly renowned scientist and physicians to offer the latest techniques and adjuncts to the current treatment plan. In addition, clinical trials allow patients participate in the latest stroke research and take advantage of emerging medications and treatments.

To best serve our community, Wellstar Kennestone Regional Medical Center and Wellstar North Fulton Medical Center are Advanced Comprehensive Stroke Centers. Wellstar Cobb and Spalding medical centers are Disease Specific Care Certified as Advanced Primary Stroke Centers. In addition, these Wellstar hospitals have achieved the American Heart Association and American Stroke Association Get with the Guidelines Gold Plus Achievement Award and are on the Target Stroke Honor Role Elite. The Wellstar Stroke Center at Wellstar Cobb Medical Center is accredited by the Joint Commission as a Stroke Center of Excellence and features a CARF certified in-patient Rehabilitation program on campus. Wellstar Douglas Medical Center is a certified Remote Stroke Treatment Center.

All Wellstar hospitals partner with skilled and compassionate emergency responders through Emergency Medical Systems, each covering designated areas to best serve our communities. In addition, Wellstar hospitals utilize a Transfer Call Center to help facilitate the transfer of an acute stroke patient to Wellstar Kennestone Regional Medical Center. When a stroke patient needs a higher level of care or a specific procedure, the Transfer Call Center works off established protocols to expedite a safe transfer between hospitals when needed. The Transfer Center also works with outlying hospitals and their acute neurologic needs to facilitate transfers to Wellstar Kennestone Regional Medical Center

Wellstar Hospital System is proud to announce our partnership with the Mayo Clinic Care Network. This provides our doctors and other specialists with access to Mayo-reviewed medical information and guidelines. It connects our front line physicians to expert consultation and research surrounding the best treatment plans for our sickest and most complex patient population.

Stroke Signs and Symptoms

Call 911 immediately if you believe you or someone else is having a stroke! Think of the acronym FAST to remember symptoms.

F- Facial drop or uneven smile
A- Arm/leg numbness or weakness, loss or coordination or balance
S- Slurred speech, difficulty speaking or understanding simple commands
T- Time to call 911 and get to the hospital immediately; note the time so you'll know when the first symptoms appeared

In addition to the F.A.S.T. symptoms (facial droop, arm/leg weakness/loss of coordination or balance, slurred speech and difficulty speaking or understanding simple commands), other signs of a stroke include:

Dizziness
Paralysis on one side of the body or face (if you try to raise both arms over your head and one begins to fall, it may indicate a stroke)
Sudden vision problems
Sudden, severe headache—with no known cause
Sudden trouble seeing in one or both eyes

Women may report unique stroke symptoms including the sudden onset of:

Face and limb pain
Nausea
General weakness, more on one side

Not all symptoms will be apparent with every stroke. If any of these symptoms appear, get immediate medical help – call 911

Risk Factors

Many risk factors for stroke are the same for men and women.

Risk Factors we Can Change or Control:

Uncontrolled high blood pressure, the number one risk factor for stroke.
Atrial fibrillation (irregular heartbeat)
Heart disease
High cholesterol
Cigarette smoking
Diabetes
Being overweight
Physical inactivity
Use of alcohol, cocaine and other drugs

Risk Factors that we Cannot change or Control

Family history of stroke
Race. African-Americans have a higher risk of death from stroke than Caucasians.
Age. The risk of stroke approximately doubles for each decade after age 55
Prior stroke or Transient Ischemic Attack (TIA) also known as a “warning stroke” that has similar symptoms but does no lasting damage. Women suffer more strokes than men. And certain risks are unique to women. Among these: Note: Please talk to your doctor prior to stopping any medication you are on.
Taking birth control pills and smoking increases your risk for stroke.
Using Hormone Replacement Therapy (HRT), a combined therapy of progestin and estrogen to relieve menopausal symptoms.
Having a thick waist and high triglyceride (blood fat) level.
Suffering from migraine headaches. Migraine can increase a woman's stroke risk 3-6 times; most Americans who suffer migraines are women.

Ischemic Stroke Prevention

According to the American Stroke Association, 80% of all strokes can be prevented. The key is to identify and manage risk factors, including high blood pressure, cigarette smoking, atrial fibrillation and physical inactivity. Another very important aspect to stroke prevention is complying to your medication regimen. Always talk to your doctor before stopping any of your medications especially for Blood Pressure control, Diabetes control, Antiplatelet therapy, Anticoagulation therapy and Cholesterol lowering therapy.

Medical Treatment

Your Wellstar physician may recommend certain medications to control high blood pressure and/or manage atrial fibrillation in high-risk patients.

Anticoagulants: like warfarin interfere with the blood’s ability to clot and can play an important role in preventing stroke if you have been diagnosed with an irregular heartbeat.
Anti-platelet: like Aspirin or Plavix (clopidogrel bisulfate) work by inhibiting the production of thromboxane which is necessary for the clotting mechanism to work.
Antihypertensives: These medicines treat high blood pressure (hypertension). They can lower blood pressure by opening the blood vessels, decreasing the blood volume or decreasing the rate and/or force of heart contractions.
It is extremely important to be compliant with the medication treatment plan your and your doctor have created. Always make sure you have enough medication before a long weekend or vacation.

Medical Procedures

Certain procedures can help reduce the buildup of plaque, or remove a blockage in the artery.

Carotid endarterectomy (carotid artery surgery) involves surgical removal of the fatty plaque in the carotid arteries of the neck.
Angioplasty/stent involves the placement of tiny balloons and implantable steel screens called stents to help open up blocked blood vessels.
Mechanical thrombectomy or clot retrieval has provided additional options for the treatment of the acute ischemic stroke that is unaffected by current pharmacological treatment. A mechanical thrombectomy is considered both a primary and adjunct treatment for and ischemic stroke. Although, like IV rt-PA (altaplase), a window of time, approximately 8 hours of last known normal is a consideration. This procedure carries additional risk for complications however our physicians at Wellstar Kennestone are trained to properly screen and consent with each intervention. The goal of mechanical thrombectomy is similar to a cardiac catheterization; however, the skilled neurovascular physician retrieves the clot from a patient’s blood vessel in the brain to restore immediate blood flow to the compromised area.

Ischemic Stroke Diagnosis

Once a patient arrives at the hospital Wellstar physicians will use a computer-imaging test to determine the type of stroke and the area of the brain affected. The physician will ask about symptoms, their timing, what you were doing when they began and whether you still have them. The doctor will want to know about all medications you take, whether you’ve had a head injury and any family history of stroke or heart disease.

Listening with a stethoscope can indicate hardening of the arteries (atherosclerosis) and examining the back of your eyes can reveal tiny clots in the blood vessels there.

Diagnostic Tests

Wellstar physicians use a variety of brain imaging techniques to determine if you are having/had a stroke, its type and where it is occurring. Imaging methods include:

Computerized tomographic brain scan (CT of the brain) which is a very quick and easy way to detect if the symptoms are caused by a bleed in the brain. The initial CT scan is used simply to rule out a head bleed in the early stage of an acute ischemic stroke. Every suspected stroke will receive an initial head CT upon arrival to the emergency department.

Further diagnostic testing may include:

Computerized tomographic angiography (CTA) involves injecting a dye in the bloodstream and taking X-rays to create a 3D image of the blood vessels of the neck and brain. CTA can reveal bleeding in or around the brain. If none is found, a diagnosis of ischemic (blockage) stroke is made.
Magnetic resonance imaging (MRI) also creates a 3D image of the brain.
Carotid ultrasound uses sound waves to reveal narrowing or clotting in the carotid arteries of the neck.
Arteriography involves injection of a dye into a specific artery through a catheter to provide X-ray images.
Echocardiography is an ultrasound image to determine if a clot from the heart has traveled to the brain, causing a stroke.

Ischemic Stroke Treatment

Once a patient arrives at the hospital Wellstar Emergency physicians will quickly evaluate the patient that includes a STAT CT of the head. This will tell the physician if the patient is experiencing an ischemic stroke or a hemorrhagic stroke. Once the hemorrhagic stroke has been ruled out – a more thorough neurological exam will be performed. If the patient arrives to our emergency department within 4.5 hours of the patients’ last known normal, he/she will be considered for IV Thrombolytic medication called Activse (rt-PA). This is a clot buster medication approved by the FDA for patients presenting with stroke signs and symptoms from 3 hours of onset. Activase (rt-PA) was approved for ischemic stroke in 1996 by the FDA with specific indications and contraindications your doctor will discuss with you to determine candidacy for the treatment. Each qualified patient will be reviewed for any contraindication to the administration to this medication for treatment of their stroke.

Literature suggests extending the 3 hour window out to 4.5 hours from the onset of symptoms as best practice. The extended window comes with additional criteria the patient must meet prior to receiving this medication. Wellstar health system recognizes the expanded window as a best practice and includes this into their treatment protocol.

An additional treatment for the acute ischemic stroke is called a Mechanical Thrombectomy. This procedure can be performed in conjunction with IV t-PA or in lieu of IV t-PA if the patient is not a candidate for the IV thrombolytic medication. A Mechanical Thrombectomy is a procedure where a tiny catheter is fed through the patients groin and by the guidance of a skilled endovascular physician, makes its way to the clot in the brain. Our skilled endovascular physicians will then attempt to pull the clot out of the vessel hoping to restore blood flow to the area that was blocked causing the stroke. This is a consented procedure performed in the Vascular Operating room and carries an approximate 10% risk of complication. Within the Wellstar Health System, this treatment is ONLY performed at Kennestone Hospital.

After the emergency treatment, you will be monitored for any signs of complications from the stroke or from any treatment you may have received for the stroke. The nursing staff will be checking your vital signs and performing neurological exams to ensure your progress is accurately communicated to the Neurologist. This is typically when you will undergo additional testing for your stroke which will help you plan for discharge.

Ongoing Care for Ischemic Stroke

Ischemic stroke is a leading cause of disability in adults and places a great burden on patients and their families. However, even if portions of the brain are lost in a stroke, patients can benefit from a number of excellent therapies.

If needed, your physician will work to develop an individualized rehabilitation program with the specialists at the Wellstar Kennestone Outpatient Neuro-Rehabilitation program. The program serves patients in the acute care hospital setting, inpatient rehab unit and outpatient settings.

There are four locations—Wellstar Cobb Medical Center, Wellstar Kennestone Regional Medical Center, Wellstar Douglas Medical Center (speech only) and Wellstar Windy Hill (speech only).

Physical therapists, occupational therapists and speech therapists address issues including:

Regaining independence with daily activities
Regaining functional use of arm and hand
Restoring mobility
Improving balance
Improving cognitive (thinking) skills including memory and attention
Improving language and word-finding skills
Swallowing difficulties
Patient and family education
Brain injury support groups at the Marietta campus (free of charge)
For a support group near you please visit: Brain Injury Association of Georgia

If the stroke has damaged the parts of the brain responsible for speech, it may be necessary to relearn language skills. Fortunately the brain has a great ability to learn and adapt, so other portions of the brain can be trained to take over lost communication function. With time, survivors of strokes that impact speech usually regain some or all previous language ability.

Many stroke patients also require psychiatric or psychological care including counseling and medication to help with depression, frustration and anger resulting from their strokes. Under the care and treatment of our Physiatrists and extended care team, all aspects of the stroke survivor is addressed.

Smoking Cessation

Wellstar offers smoking cessation programs that educate people about smoking risks, encourage behavior modification to help minimize smoking urges and offer numerous coping strategies. Several different methods for changing smoking behavior are explored so that individuals learn approaches that work best for them.