Stroke in the News
New Multi-Institutional Partnership to Focus on Stroke Rehabilitation
Monday, May 20, 2019
The University of Rochester Medical Center (URMC), Burke Neurological Institute, and Wadsworth Center of the New York State Department of Health (NYSDOH) have been awarded a $5 million grant from the Empire State Development Corporation to speed the development of ground-breaking neurological treatments for those disabled from stroke.
The project is a part of the NeuroCuresNY (NCNY) initiative, a new non-profit formed by the three institutions to accelerate the discovery of novel treatments for chronic neurological impairment and disability. The new state funding will support a two-year pilot study that will be launched in January 2020. This study design will be unique because it will test the efficacy of state-of-the-art robotic-assisted rehabilitation technology combined with drugs to improve the functional recovery of stroke patients.
Neurological conditions such as stroke, traumatic brain injury and spinal cord injury permanently disable more than one million people each year in the U.S., and stroke is the nation’s leading cause of disability. Clinical trials for neurological disabilities and impairments are usually passed over because of unclear results, high costs, and challenges in recruiting participants. NCNY will seek to lower the barriers to participation in clinical trials by assisting with travel funding for patients, while providing a supportive and guiding environment for patients and their families.
Clinical and research faculty from URMC Departments of Neurology, Neurosurgery, and Physical Medicine & Rehabilitation will collaborate with the UR Neurorestoration Institute during the pilot study.Read More: New Multi-Institutional Partnership to Focus on Stroke Rehabilitation
Mobile Stroke Unit puts Rochester among nation's fastest for stroke response
Tuesday, March 12, 2019
After actor Luke Perry died of a stroke last week, there has been an increased interest in learning about and preventing strokes.
Six months after UR Medicine launched the first mobile stroke unit in New York outside of New York City, patients are being treated within minutes, instead of hours.
The first steps to take for any potential stroke patient are to undergo a brain scan and then be given a life-saving drug called TPA.
The national standard response time for those steps to be administered is just under 60 minutes. With UR Medicine, they averaged about 50 minutes.
But when the Mobile Stroke Unit was brought in, UR Medicine cut its response time down to nine minutes. That is among the fastest in the nation.
"This is progress, but I think we can do better," said Dr. Tarun Bhalla, director of the Stroke and Cerebrovascular Services at UR Medicine. “I think the full potential of this unit has yet to realized. We’re still in the pilot phase and we’re gonna continue to push the envelope.”
Dr. Bhalla said the ambulance is also sparking discussion about recognizing the signs and symptoms of a stroke. Strokes are commonly referred to as "brain attacks" caused by a blocked or burst blood vessel.
"Learn to recognize the signs of a stroke," Dr. Bhalla said "If you see someone with weakness in their face or arm or has speech difficulty, realize that time is of the essence and you need to call 911 immediately to get to your local emergency room.”
The UR Mobile Stroke Unit is an emergency room on wheels. A specialized crew on board performs CT scans, blood tests, and administers life-saving medicines before arriving at the hospital.
Time saved means fewer dead brain cells - and that can mean a world of difference to stroke patients.Read More: Mobile Stroke Unit puts Rochester among nation's fastest for stroke response
UR Medicine Unveils Upstate New York’s First Mobile Stroke Unit
Thursday, September 27, 2018
Next month, UR Medicine will begin operation of a Mobile Stroke Unit (MSU), a high-tech ‘emergency room on wheels’ that is designed to provide life-saving care to stroke victims. The $1 million unit will be operated in partnership with AMR as a community resource and represents a significant step forward for stroke care in the Rochester region.
While the MSU resembles an ambulance on the outside, inside it contains highly specialized staff, equipment, and medications used to diagnose and treat strokes. The unit is equipped with a portable CT scanner that is capable of imaging the patient’s brain to detect the type of stroke they are experiencing. The scans and results from a mobile lab on the unit are wirelessly transmitted to UR Medicine stroke specialists at Strong Memorial Hospital, who will consult with the on board EMS staff via telemedicine and decide if they can begin treatment immediately on scene.
If it is determined that the patient is experiencing an ischemic stroke – which account for approximately 90 percent of all strokes – the MSU team can administer the drug tissue plasminogen activator (tPA) to attempt to break up the clot in the patient’s brain. While en route to the hospital, UR Medicine specialists will continue to remotely monitor and assess the patient’s symptoms.
“The UR Medicine Mobile Stroke Unit essentially brings the hospital to the patient,” said neurosurgeon Tarun Bhalla, M.D., Ph.D., with the UR Medicine Comprehensive Stroke Center. “This unit will improve care and outcomes by shortening the gap between diagnosis and treatment and enable us to initiate care before the patient reaches the hospital.”
It is estimated that 3,000 people in Monroe County suffer from a stroke every year. Stroke is the fifth leading cause of death and the number one cause of long-term disability in the U.S. However, if caught early, many stroke victims can make a full recovery.
“Ten years ago we realized there was an epidemic of stroke in our community which resulted in tremendous human suffering and health care costs,” said Web Pilcher, M.D., Ph.D., chair of the UR Medicine Department of Neurosurgery. “We decided to embark on a long-term plan to provide the best stroke care in upstate New York. The Mobile Stroke Unit represents the next evolution in that effort and places Rochester among an elite list of communities with this cutting-edge technology.”
The current best treatment for stroke is tPA. But in order to work properly, the drug must be given within four and half hours of the first stroke symptoms. Depending upon the circumstances, doctors may also elect to perform a minimally invasive endovascular surgical procedure that involves threading a catheter through the blood vessels and physically removing the obstruction in the brain. The capabilities provided by the MSU to diagnose, start treatment, and prepare hospital staff to receive the patient before they arrive at the emergency department will save lives and improve chances of recovery.
“In stroke care, time equals brain,” said neurologist Curtis Benesch, M.D., M.P.H., with the UR Medicine Comprehensive Stroke Center. “The approximately 30 minutes that could be saved by the Mobile Stroke Unit by starting treatment before a stroke patient reaches the hospital could mean the difference between the recovery of function or a lifetime of impairment.”
“Patients who receive tPA sooner are more likely to go home and retain the ability to walk and care for themselves,” said Bob Holloway, M.D., M.P.H., chair of the UR Medicine Department of Neurology. “The Mobile Stroke Unit will improve outcomes for stroke victims in our community and, because people with less disability use fewer health care resources, lower costs in the long term.”
The unit is owned by UR Medicine and will be operated by AMR. The MSU will be staffed by a UR Medicine nurse trained in stroke care and a CT technician, an AMR paramedic and emergency medical technician, and remotely by a stroke specialist at UR Medicine.
The construction and operating costs of the unit, which was custom built by Frazer Ltd. in Houston, are being funded by UR Medicine and philanthropy, including a lead gift from Elena Prokupets and support from the Del Monte family and other donors in the Rochester community.
“We are extremely grateful to Elena for her gift to the School of Medicine and Dentistry, which has made it possible to bring this life saving technology to Rochester,” said Mark Taubman, M.D., CEO of the University of Rochester Medical Center. “Her generosity, along with the support of many others, has provided us the resources to invest in the infrastructure, technology, and clinical talent necessary to provide the most advanced stroke care to our community.”
The MSU is part of a broader UR Medicine initiative to bring state-of-the-art stroke care to the region. This includes Strong Memorial Hospital’s designation as the region’s only Comprehensive Stroke Center by the Joint Commission, a certification that indicates that the hospital either meets or exceeds the highest standards of care required to provide timely, advanced, and coordinated care to patients with cerebrovascular disease, and the Neuromedicine Intensive Care Unit, a 12-bed ICU that provides care to critically ill patients with complex neurological life threating illnesses such as stroke. UR Medicine stroke specialists also provide 24/7 consultation services for emergency department personnel in several hospitals in the region via telemedicine.
Eight years ago, UR Medicine, in partnership with the Greater Rochester Health Foundation, created the Stroke Treatment Alliance of Rochester/New York (STAR-NY), to educate medical professionals and the broader community about stroke recognition and prevention.Read More: UR Medicine Unveils Upstate New York’s First Mobile Stroke Unit
AHA Grants Will Accelerate Search for New Stroke Therapies
Wednesday, June 27, 2018
A series of awards from the American Heart Association (AHA) to a team of researchers at the University of Rochester Medical Center (URMC) will focus on the development of new treatments to thwart the damage in the brain caused by stroke.
One of the research projects brings together experts in stroke, cardiovascular biology, platelet biology, and peptide chemistry. Marc Halterman, M.D., Ph.D., with the URMC Center for Neurotherapeutics Discovery, Scott Cameron, M.D., Ph.D., and Craig Morrell, D.V.M., Ph.D., with the URMC Aab Cardiovascular Research Institute, and Bradley Nilsson, Ph.D., with the University of Rochester Department of Chemistry will focus on the role that platelets play in acute brain injury and inflammation during stroke.
Platelets serve an important role in protecting against blood loss and repairing injured blood vessels. However, during a stroke the inflammatory properties of platelets can interfere with the restoration of blood flow once the clot in the brain is removed, particularly in micro-vessels, which can lead to permanent damage of brain tissue.
The research team will build synthetic peptides that activate platelets to study the phenomenon – which is called no-reflow – in an effort to identify specific switches within platelets that can be turned off and limit the cells’ inflammatory functions without blocking their ability to prevent bleeding.
Two AHA pre-doctoral fellowship awards Kathleen Gates and Jonathan Bartko in Halterman’s lab will support research that examines the link between an immune system response triggered by stroke in the lungs that can exacerbate damage in the brain and investigate the cellular mechanisms that determine whether or not brain cells die following stroke.
A final AHA award to the Halterman lab will seek to identify new drug targets by focusing on specific proteins activated during stroke that are suspected to play an important role in determining the survival of neurons.
Collectively, the AHA Collaborative Sciences Award, Pre-Doctoral, and Innovation awards represent $1.09 million in funding.Read More: AHA Grants Will Accelerate Search for New Stroke Therapies
UR Medicine Recognized for Excellence in Stroke Care
Monday, June 11, 2018
The American Heart Association/American Stroke Association (AHA/ASA) has once again honored the UR Medicine Strong Memorial Hospital for having achieved the highest standard of care for stroke. This award identifies hospitals that provide care that can speed the recovery and reduce death and disability for stroke patients.
Strong Memorial Hospital has received the 2018 AHA/ASA Get With The Guidelines program’s Stroke Gold Plus Quality Achievement Award. The hospital was also recognized for the Target: Stroke Honor Role Elite Plus designation, which identifies hospitals that have consistently and successfully reduced door-to-needle time – the window of time between a stroke victim’s arrival at the hospital, the diagnosis of an acute ischemic stroke, and the administration of the clot-busting drug tPA. If given intravenously in the first four and a half hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability.Read More: UR Medicine Recognized for Excellence in Stroke Care
Neurology and Neurosurgery Earn Top 50 Ranking in U.S. News & World Report's 'Best Hospitals'
Wednesday, August 9, 2017
Strong Memorial Hospital’s Neurology and Neurosurgery specialty program has been ranked among the top 50 in the nation for 2017-2018 by U.S. News & World Report. The program ranked 39th among the nation’s hospitals, and this is the seventh consecutive year it has been nationally ranked by U.S. News.
In June, UR Medicine’s Golisano Children’s Hospital was recognized as one of the nation’s best children’s hospitals in three specialty areas — Neonatology, Nephrology, and Neurology and Neurosurgery — in the U.S. News & World Report’s Best Children’s Hospital rankings.
For the 2017-18 adult rankings, U.S. News evaluated more than 4,500 U.S. hospitals; only 152 were ranked in at least one specialty.
Eight Strong Memorial Hospital specialty programs earned High Performing ratings: Cardiology and Heart Surgery, Diabetes and Endocrinology, Gastroenterology and GI Surgery, Geriatrics, Nephrology, Orthopaedics, Pulmonology, and Urology.
U.S. News recognized hospitals that were high-performing across multiple areas of care and ranked them within their states and by metropolitan areas. U.S. News rated Strong Memorial as the top hospital in the Rochester Metro area and fourth among New York state hospitals.
U.S. News evaluates nearly 5,000 hospitals nationwide for its Best Hospitals rankings; methodologies include objective measures such as patient survival, the number of times a given procedure is performed, infection rates, adequacy of nurse staffing and more.
Read More: Neurology and Neurosurgery Earn Top 50 Ranking in U.S. News & World Report's 'Best Hospitals'
Surviving a Stroke Propels Career in Brain Research
Wednesday, July 26, 2017
Left to right: Brad Mahon, Frank Garcea, and Edward Vates
On a warm day in July 2005, Frank Garcea’s soccer playing days came to an abrupt end when he suffered what could have been a deadly stroke during a practice with his teammates. Instead, the events of that day and his subsequent treatment – which serve as the basis for a review published in the New England Journal of Medicine (NEJM) – set him on a career path that would ultimately lead to a Ph.D. studying how the brain recovers from injury.
Garcea, who was about to begin his senior year at the Aquinas Institute in Rochester, was in the middle of a training session when he started experiencing a pounding headache. He first suspected he might just be dehydrated on that hot summer day, but soon after his limbs began to tingle and grow numb, his eyes became sensitive to the bright sunlight, and he had difficulty walking. Very quickly it became obvious that something was wrong and someone called 911.
Garcea eventually ended up at Strong Memorial Hospital and was diagnosed with a subarachnoid hemorrhage. He would undergo surgery the next morning under the clinical care of UR Medicine neurosurgeon Edward Vates, M.D., Ph.D.
Subarachnoid hemorrhages account for approximately 5-10 percent of all strokes in the U.S. These occur when a blood vessel in the brain bursts causing bleeding. If not treated immediately, these strokes can cause major disability and, in many cases, death.
“When an aneurysm ruptures, it is an intracranial catastrophe,” said Vates, a co-author of the NEJM article. “In 25 to 50 percent of cases, these strokes result in death, and this estimate does not fully account for patients who die before receiving medical attention.”
Vates uses Garcea’s experience as jumping off point to describe the decision-making process required to diagnose and identify treatment options for subarachnoid hemorrhages. Read More: Surviving a Stroke Propels Career in Brain Research
UR Medicine Recognized for Stroke Care
Tuesday, June 27, 2017
The American Heart Association/American Stroke Association (AHA/ASA) has once again honored the UR Medicine Strong Memorial Hospital as having met its highest standards of care for stroke.
Strong Memorial Hospital has received the AHA/ASA Get With The Guidelines program’s Stroke Gold Plus Quality Achievement Award. The hospital was also tapped for the Target: Stroke Honor Role Elite Plus, which recognizes hospitals that have consistently and successfully reduced door-to-needle time – the window of time between a stroke victim’s arrival at the hospital, the diagnosis of an acute ischemic stroke, and the administration of the clot-busting drug tPA. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability.
“This recognition is a testament to the hard work of our outstanding team of nurses, physicians, and therapists and their dedication to provide the highest quality of care to stroke victims,” said neurologist Curtis Benesch, M.D., M.P.H., the medical director of the UR Medicine Comprehensive Stroke Center.
“This award reflects a singular focus on improving the care stroke victims receive from the first 911 call to when they arrive at the hospital through operating room, neurocritical care, and rehabilitation,” said Tarun Bhalla, M.D., Ph.D., the surgical director of the Comprehensive Stroke Center.
Strong Memorial Hospital is home to the region’s only Comprehensive Stroke Center, a designation by the Joint Commission that indicates that the hospital either meets or exceeds the highest standards of care required to provide timely and comprehensive care to patients with complex cerebrovascular disease.
The AHA/ASA Get With the Guidelines program recognizes hospitals that have reached aggressive goals of treating stroke patients and comply with core standard levels of care. For more information about the Get With The Guidelines program, visit the AHA/ASA website. Read More: UR Medicine Recognized for Stroke Care
Protein Key to Nerve Health Hitches a Ride on Brain’s Garbage Truck
Thursday, March 9, 2017
A new study shows that the brain’s waste removal system serves as both trash collector and delivery service, providing neurons with a protein important to maintaining cognitive function while simultaneously cleaning brain tissue. The research may help explain why different genetic varieties of the protein, called apolipoprotein E (apoE), can indicate risk for Alzheimer’s disease or promote longevity.
The study was led by Rashid Deane, B.Sc., Ph.D., a research professor in the University of Rochester Medical Center Department of Neurosurgery and member of the Center for Translational Neuromedicine, and appears in the journal Molecular Neurodegeneration.
ApoE is responsible for delivering cholesterol to nerve cells in the brain and plays a key role in synaptic plasticity, the process by which neurons build new connections in order to learn and store memories.Read More: Protein Key to Nerve Health Hitches a Ride on Brain’s Garbage Truck
Study: Home Care Improves Stroke Outcomes
Thursday, March 2, 2017
Stroke patients who are paired with caregivers that help them transition back
to their homes are significantly less likely to be readmitted to the hospital. The results of the pilot study, which showed a 39 percent reduction in the readmission rates of stroke patients at Strong Memorial Hospital, were presented last week
at the International Stroke Conference in Texas.
The study was authored by Ann M. Leonhardt Caprio, M.S., R.N., A.N.P. and Curtis G. Benesch, M.D., M.P.H. with the UR Medicine Comprehensive Stroke Center, and Denise Burgen, M.B.A.,
M.S.N., F.N.P, R.N. with UR Medicine Home Care.
The study focused on one of the measures used by the Centers for Medicare and Medicaid Services to determine quality of stroke care – whether or not a patient is readmitted to the hospital within 30 days of being discharged after suffering a stroke.Read More: Study: Home Care Improves Stroke Outcomes
Faculty Reflect on SMH Stroke Center Highlighted in Super Bowl Ad
Wednesday, February 1, 2017
A new ad that will premiere during the Super Bowl focuses on Strong Memorial Hospital’s Comprehensive Stroke Center. You can watch it here. We asked neurologist Curtis Benesch, M.D., M.P.H., and neurosurgeon Tarun Bhalla, M.D., Ph.D., about UR Medicine’s stroke care and what is being done to improve access for patients across the region.
What does SMH’s designation by the Joint Commission and American Heart Association/American Stroke Association as a Comprehensive Stroke Center mean?
Benesch: Designation as a Comprehensive Stroke Center indicates that our center either meets or exceeds the highest standards of care required to provide timely and comprehensive care to patients with complex cerebrovascular disease. Our site has undergone rigorous site visits and annual reviews by the Joint Commission to ensure that we satisfy all the requirements for this designation, including metrics for primary stroke care, surgical stroke care, endovascular care, critical care, longitudinal outpatient care, research, education and outreach.
How does this designation differentiate the hospital from other stroke centers?
Bhalla: All Comprehensive Stroke Centers must provide neurosurgical care, endovascular care, and neuro-critical care. These efforts are enabled in part by a well-established interdisciplinary infrastructure of exemplary stroke care (EMS, emergency medicine, nursing, therapy, and rehabilitation). Although other sites in the region may provide some of these aspects of care, UR Medicine is the only certified Comprehensive Stroke Center in Rochester, reflecting our willingness to submit to the scrutiny of external review to ensure we meet those high standards. It is not just a label but rather a public affirmation of the breadth and depth of a large multidisciplinary team of providers working together.
What is being done to extend stroke care across the health system? For example, if you are a stroke patient and you arrive at a regional hospital supported by UR Medicine, what does that mean for the care you receive?
Benesch: We support all of our regional partners with immediate availability of consultations with experts in Cerebrovascular Neurosurgery, Stroke Neurology, and Neurocritical care. These experts can help in acute treatment decisions and, with our transfer center, can facilitate transfer of patients to Strong Memorial Hospital as needed. Furthermore, we have developed a coverage model to provide 24/7 telestroke consultation to hospitals across the region in an effort to enhance acute stroke care.
Providing timely, appropriate, and comprehensive care for stroke patients requires a high level of coordination and collaboration among caregivers. What is necessary to facilitate communication, coordination, and continuity of care across the team?
Bhalla: First and foremost, the team has to believe in the concept that the more of a difference that we can make up front, the better a stroke patient will fare in the long run. The care they receive from the first 911 call to when they arrive at the hospital is only the beginning of a journey that continues through operating room, neurocritical care, and rehabilitation and is one that will determine how much function a stroke victim will ultimately recover. We all play a part, but everyone must share the same vision. Internally, it means that all the groups that represent the continuum of care must continually focus on ways to improve communication and coordination. But this also requires building awareness and education within the community. People need know how to identify the signs of stroke and EMS providers need to know what to do and where to take patients.
What does the future hold for stroke care?
Bhalla: We are committed to continuing to find creative ways to deliver the highest level of stoke care to patients where and when they need it. This includes working with community providers and partnering with EMS to leverage the resources of our Comprehensive Stroke Center to diagnose and potentially begin treatment for stroke patients even before they reach the hospital.