Advanced treatments from stroke experts

Advanced Stroke Treatment at LifeBridge Health Stroke Quality Measures at LifeBridge Health Find a Doctor Related Services

Advanced treatments from stroke experts

The region’s most capable professionals in stroke management are collaborating at the Thrombectomy-Capable Stroke Center at Sinai Hospital and at the Primary Stroke Centers at Northwest and Carroll hospitals, where we provide patients with advanced treatments for acute stroke.

IV Alteplase

One treatment used for acute ischemic (nonbleeding) stroke is IV alteplase (tPA, tissue plasminogen activator), which is a medication that breaks up blood clots. It is given to eligible patients who arrive at the hospital within a certain period of time after the onset of their stroke symptoms. Although this medication has shown to be beneficial in decreasing the amount of disability that a person experiences after a stroke, it does have some potential complications. One of these complications is that use of this medication may cause bleeding in the brain, known as a symptomatic hemorrhage.

In 1995, the NIH’s National Institute of Neurological Disorders and Stroke conducted a clinical trial to study the use of alteplase.1 This study proved to be a very important trial, with far-reaching results that influenced the treatment of patients with stroke worldwide.

The study showed benefit of using alteplase to treat acute ischemic (nonbleeding) strokes, with hemorrhage occurring in 6.4% of treated patients. In comparison, at Sinai Hospital’s Thrombectomy-Capable Stroke Center in calendar year 2023, alteplase was used to treat 76 patients with 4 occurrences of symptomatic hemorrhage.

1 National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333(24):1581–7.

Mechanical Thrombectomy

Another stroke treatment offered at Sinai Hospital is mechanical thrombectomy, also known as endovascular therapy. This procedure is provided to a patient who has a blood clot blocking a large blood vessel in the brain. During this procedure a specially trained doctor, called a neurointerventionalist, uses a catheter to manually remove a blood clot from the blood vessel.

Complications from this procedure may include having a new stroke, damaging a blood vessel, or bleeding in the brain during or after the procedure.

Results of a mechanical thrombectomy are described using a TICI (thrombolysis in cerebral infarction) score, which describes how well the blood flows through the vessel after the procedure is completed. A good outcome for stroke patients who have this procedure is demonstrated by a TICI score of 2b or 3, which means that 50%–100% of blood flow has been restored to the brain.

In February 2018, results of an important and widely publicized study in the treatment of stroke were reported. The study, called DEFUSE 3 included 182 patients from 38 medical facilities in the United States.2 In this study, 7% of patients who received endovascular therapy experienced hemorrhage (bleeding in the brain). At Sinai Hospital’s Thrombectomy-Capable Stroke Center Center in calendar year 2023, 5% (4 out of 80 patients who received endovascular therapy) experienced symptomatic hemorrhage.

In the DEFUSE 3 study, 76% of patients had TICI scores of 2b/3. In comparison, at Sinai, in calendar year 2023, 93.8% (75 out of 80) had TICI scores of 2b/3.

2 Albers GW, Marks MP, Kemp S, et al.; DEFUSE 3 Investigators. Thrombectomy for stroke at 6–16 hours with selection by perfusion imaging. N Engl J Med 2018; 378(8):708–18.

Advanced Stroke Treatment at LifeBridge Health

To provide the best possible care and best outcomes for our patients, LifeBridge Health has established a stroke-management “NeuroRescue Network,” with the goal to decrease complications from the disease while increasing the efficiency of care. Patients with stroke require special attention and testing, especially because the minutes after a stroke are crucial. These patients often have multiple health problems that require continuous medical attention to reduce the risks of future strokes. The network's streamlined system allows patients to benefit from faster treatment and discharge to a rehabilitation program, all at a lower cost. Such dedicated stroke units and specialized care are associated with decreased lengths of stay, institutionalization, dependency, and death.

The Thrombectomy-Capable Stroke Center at Sinai Hospital was the first center in the state to deploy RAPID software, and the LifeBridge Health System is the only hospital system to have RAPID deployed at all of its facilities. The RAPID (RApid processing of Perfusion and Diffusion) system allows for comparison of MRI and CT perfusion studies to determine the amount of brain tissue that can be treated and saved.

RAPID technology allows LifeBridge Health practitioners to treat patients, who would otherwise likely be left with significant speech, language, and health deficits. Our use of this breakthrough technology avoids unnecessary transfers, enhances patient experience, and improves overall quality of care for patients with signs and symptoms of stroke.

The LifeBridge Health Stroke Center of Excellence includes the following interdisciplinary components:

  • Focused, interdisciplinary stroke team that ensures appropriate protocols are employed to support early diagnosis and optimal intervention

  • Highly qualified neurologists and neurointerventionalists who provide 24/7 coverage

  • Specialized acute care delivered by stroke specialists during the critical early recovery stage

  • Use of advanced interventional approaches that incorporate leading-edge technologies to support improved outcomes

  • Participation in clinical research trials to support early adoption of promising stroke technologies and clinical practices

  • Formalized screening and education programs that raise awareness of stroke

  • Integrated rehabilitation program that provides customized patient support and increases compliance with preventive therapies

  • Quality improvement program that focuses on streamlining processes to bring evidenced-based care safely and rapidly to the patient

Stroke Quality Measures at LifeBridge Health

Sinai Hospital of Baltimore
The stroke center at Sinai Hospital is accredited as a Thrombectomy-Capable Stroke Center by The Joint Commission and by Maryland Institute for Emergency Medical Services Systems (MIEMSS), signifying that it meets the highest national standards and has the critical elements to achieve long-term success in improving outcomes. It also means that community hospitals that do not have stroke services transport patients to Sinai for advanced care.

Through its “Get with the Guidelines” (GWTG) program, the American Heart Association/ American Stroke Association (AHA/ASA) has recognized Sinai Hospital since 2007 for its compliance with quality-achievement measures in the treatment of stroke. As the GWTG program has progressed, the AHA/ASA has introduced new award categories—each one setting the bar higher toward improving patient care; and each time, Sinai succeeded in hitting the bar, receiving the highest award possible every year since 2008.

In 2023, Sinai received the—“GWTG-Stroke Gold Plus Performance Achievement Award Target: Stroke Honor Roll Elite Plus, and Target: Type 2 Diabetes Honor Roll”—for achieving ≥85% compliance with all GWTG-Stroke Achievement Measures and achieving ≥75% compliance with 5 or more GWTG-Stroke Quality Measures for more than 2 consecutive 12-month periods.

Sinai Hospital also qualified for the Target: Stroke Honor Roll Elite Plus, and Target: Type 2 Diabetes Honor Roll award because it reduced the time between patients' arrival at the hospital and their treatment with the clot-busting tissue plasminogen activator (tPA) alteplase, the only drug approved by the US Food and Drug Administration to treat ischemic stroke. Sinai achieved the door-to-needle (DTN) time of ≤60 minutes in at least 85% of eligible patients and achieved a DTN time of ≤ 45 minutes in 75% of applicable patients and DTN of ≤ 30 minutes in 50% of eligible patients to improve quality of patient care and patient outcomes. Sinai also received the Target: Type 2 Diabetes Honor Roll award for demonstrating the most current evidenced based care.

Northwest Hospital
The stroke center at Northwest Hospital is accredited as a Primary Stroke Center by the Maryland Institute for Emergency Medical Services Systems (MIEMSS). Since 2010, the stroke program there has been recognized by the AHA/ASA, and in 2023, Northwest Hospital received the GWTG Gold Plus Performance Achievement Award Target: Stroke Honor Roll - for achieving ≥85% compliance with all GWTG-Stroke Achievement Measures and achieving ≥75% compliance with 5 or more GWTG-Stroke Quality Measures for more than 2 consecutive 12-month periods. Northwest Hospital also qualified for the Target: Stroke Honor Roll award because it reduced the time between patients' arrival at the hospital and their treatment with the clot-busting tissue plasminogen activator (tPA) alteplase, the only drug approved by the US Food and Drug Administration to treat ischemic stroke. Northwest Hospital achieved the door-to-needle (DTN) time of ≤60 minutes in at least 75% of eligible patients. Northwest Hospital also received the Target Type 2 Diabetes Honor Roll award for demonstrating the most up-to-date evidenced based care.

Carroll Hospital
The stroke center at Carroll Hospital is accredited as a Primary Stroke Center by the Maryland Institute for Emergency Medical Services Systems

(MIEMSS). Since 2010, the stroke program there has been recognized by the AHA/ASA, and in 2023, Carroll received the GWTG Gold Plus Performance Achievement Award Target: Stroke Honor Roll Elite- for achieving ≥85% compliance with all GWTG-Stroke Achievement Measures and achieving ≥75% compliance with 5 or more GWTG-Stroke Quality Measures for more than 2 consecutive 12-month periods. Carroll Hospital also qualified for the Target: Stroke Honor Roll Elite award because it reduced the time between patients' arrival at the hospital and their treatment with the clot-busting tissue plasminogen activator (tPA) alteplase, the only drug approved by the US Food and Drug Administration to treat ischemic stroke. Carroll Hospital achieved the door-to-needle (DTN) time of ≤60 minutes in at least 85% of eligible patients. Carroll Hospital also received the Target Type 2 Diabetes Honor Roll award for demonstrating the most up-to-date evidenced based care.

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