St. Clair Health: Award-Winning Stroke Care

Every 40 seconds, someone in the United States has a stroke, according to the Centers for Disease Control (CDC). That adds up to 795,000 people each year. CDC data also shows that someone dies from a stroke every 3.5 minutes, making strokes a leading cause of death in the U.S. 

St. Clair Health offers Stroke Care that has received the American Heart Association/American Stroke Association’s Get With The Guidelines®—Stroke Gold Plus Quality Achievement Award three years in a row. The award recognizes the hospital’s commitment to ensuring that stroke patients receive the most appropriate treatment according to nationally-recognized guidelines based on the latest scientific evidence. 

Leading the Stroke Care program at St. Clair is Maxim D. Hammer, M.D., MBA, Chief of Neurology, who practices with St. Clair Medical Group Neurology. Under his leadership, St. Clair has introduced a number of innovations in stroke care.

Dr. Hammer defines stroke as “a sudden neurological deficit caused by a vascular problem.” He explains that definition has three components. “One is that it happens suddenly. The second is that it's a neurological deficit, which means some loss of function such as weakness, loss of sensation, slurred speech, loss of vision, or the inability to communicate or understand people. The third is a vascular problem—in other words, a problem with the circulation. The majority of the time, a stroke is caused by a blocked artery, which cuts off blood supply. Less commonly, a stroke is caused by a ruptured or broken artery that causes bleeding in the brain.”

Time is of the essence in treating a stroke. When a stroke patient comes to the St. Clair Hospital Emergency Department, Dr. Hammer notes that it is important to determine when the stroke began and do a quick physical examination to measure the general severity of the stroke. 

“We do a CAT scan to place these patients into a category,” he says. “Is it a bleeding-kind of a stroke that will show up as blood on the CAT scan? Or is it the blocked-artery type of stroke, in which case the CAT scan will show no blood? If it's someone who has ischemic stroke where there's a blocked artery—and we can catch it early— the next step is to administer an intravenous treatment called thrombolysis, where we provide a drug called Tenecteplase to the patient. The sooner we administer it, the better the chance of recovery.”

“We previously used a drug called TPA, and we switched to Tenecteplase a year ago. The old stroke community is slowly switching to Tenecteplase because it's believed to be slightly more effective. The second thing we're doing is analyzing the delivery process of this treatment to determine what steps can be shortened. We’re aiming to deliver this medication even more rapidly than we do now, because the earlier it's given, the more effective it is,” he says.

“The next step is to determine if there's a major artery that's blocked. A second scan called a CT angiogram is done, which scans the brain and the neck to look for large artery blockage. If a major artery is blocked, then the patient might be a candidate for a procedure where the blood clot is removed. Those patients are transferred by helicopter to another hospital in Pittsburgh where that procedure can be performed. The majority of patients do not have a large artery that's blocked, so they are able to remain at St. Clair Hospital,” explains Dr. Hammer.

“The Emergency Department has been very helpful as a partner both for helping us treat acute strokes, and keeping the patients in St. Clair Hospital that are able to stay here. We developed a prediction model that will tell us which patients can safely remain at St. Clair Hospital, which is the majority of the patients that come to the Emergency Department. That way, they can continue to get care in their neighborhood hospital,” Dr. Hammer says.

Another innovative approach to stroke care at St. Clair is a video-based telestroke collaboration with Mayo Clinic. Dr. Hammer explains that stroke care is very time-sensitive. “Every minute, something like 10 million brain cells can die during stroke. If it takes the doctor on-call about 45 minutes to get to the hospital, well, that's 450 million brain cells that are potentially gone, just due to travel time,” he says. “The telestroke service allows for immediate virtual assessment of the patient by a stroke specialist, to deliver the best care as quickly as possible.” 

Dr. Hammer has also implemented a novel approach to caring for his patients once they return home. “I provide the patient and their family with a direct line to contact me,” he says. “Whatever their concerns are, they can be addressed very quickly and directly with me. In addition, I follow-up with stroke patients within days after discharge from the hospital to make sure everything is okay and to discuss any apprehensions or concerns.” 

Dr. Hammer notes that an important aspect of stroke care is preventing stroke. “Even after a stroke has occurred, we don't just want to treat the stroke that has happened. We want to make sure we fully understand the cause of that stroke, so that we can do everything we can to protect the patient from having another stroke in the future. That's actually the main goal of the Stroke Care program,” he says.

For more information about the Stroke Care program at St. Clair Health, visit stclair.org or call (412) 942-4000.