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Stroke at AGH

Allegheny General Hospital

Allegheny General Hospital was one of the first medical centers in the country and the first in western Pennsylvania to be designated as an Advanced Comprehensive Stroke Center by the Joint Commission. 

Founded in 1988, the center provides both inpatient and consultative care for stroke patients throughout western Pennsylvania and is in the lead position to advance stroke care throughout the hospitals of Allegheny Health Network. Acute stroke care is provided by stroke neurologists (24-hour service) who treat eligible acute stroke patients with intravenous tissue plasminogen activator (t-PA) and select patients for interventional stroke therapy.

The center is a highly coordinated, multidisciplinary team of board-certified neurologists, neurosurgeons and neuro-interventionalists with subspecialty expertise in cerebrovascular disease. These specialists provide comprehensive evaluation, treatment, prevention and rehabilitative services for ischemic and hemorrhagic cerebrovascular disorders.

About Us

For transfers and referrals, call 412.359.8066 or 1.888.660.4884.

With one phone call to a transfer specialist at Allegheny General Hospital, all necessary arrangements can be made to arrange requested inter-hospital transfers. If necessary, we can transport patients to our facility using an ambulance or helicopter service. This service is available 24 hours a day, seven days a week.

Neuroimaging capabilities (24-hour services) at the AGH main campus include:

  • 3 MRI scanners (1.5 Tesla) with diffusion and perfusion weighted imaging capability
  • 4 CT scanners (CT angiography and perfusion imaging)
  • Digital subtraction cerebral angiography.
  • Transcranial doppler and carotid ultrasound 

Neuroscience units at AGH include:

  • 23-bed Neurointensive Care Unit
  • 36-bed Neuroscience Unit
  • 42-bed Telemetry Monitored Unit
     

LifeFlight and the Emergency Department

LifeFlight is the aeromedical transportation system based at AGH and provides rapid transfer of stroke patients to AGH for acute stroke care. AGH offers excellent integration with EMS (paramedic) services and the emergency department evaluation of acute stroke patients has been carefully evaluated to assess barriers to rapid stroke interventions. Earlier administration of intravenous tPA is associated with a higher probability of a good outcome in acute ischemic stroke patients. To that end, AGH has joined the national Target Stroke campaign, created to help eligible acute ischemic stroke patients receive intravenous tPA treatment within 60 minutes or less. The LifeFlight program is integral to the tri-state community in achieving the Target Stroke goal of rapid stroke assessment and treatment.

What is a Comprehensive Stroke Center?

Allegheny General Hospital provides state-of-the-art stroke services at our Comprehensive Stroke Center.

Founded in 1988, AGH's stroke program fulfills the Joint Commission's criteria for a Comprehensive Stroke Center, with advanced capabilities to manage the most complex patients with stroke and intracranial hemorrhage (bleeding in the brain). Furthermore, the center provides NeuroCritical care, endovascular therapies, neurosurgical care and access to clinical trials. The AGH Comprehensive Stroke Center is a multidisciplinary team of board-certified neurologists specializing in stroke, vascular neurosurgeons, and neuro-interventionalists with subspecialty expertise in stroke.

Patients benefit from advanced stroke care resulting in improved survival and reduced disability after suffering a stroke. Acute stroke care is provided by stroke neurologists (24-hour service) at AGH who provide rapid care directly at the bedside or remotely through telemedicine to treat eligible acute stroke patients with intravenous tissue plasminogen activator (rt-PA) “clot busting medication.”

What is a Comprehensive Stroke Center?

The Joint Commission's Certificate of Distinction for Comprehensive Stroke Centers recognizes the nation's preeminent and most capable referral centers for the treatment of complex stroke injuries and cerebrovascular disease. Achievement of certification signifies that the services provided at a Comprehensive Stroke Center have the critical elements to achieve long-term success in improving outcomes. The quality care we provide is effectively managed to meet the unique and specialized needs of our stroke patients.

The Joint Commission's Comprehensive Stroke Center Certification program was developed in collaboration with the American Stroke Association and is based on the Brain Attack Coalition's "Recommendations for the Establishment of Comprehensive Stroke Centers."

The following are major services and procedures that the Allegheny General Hospital Comprehensive Stroke Center must have shown competence in to become certified by the Joint Commission as a Comprehensive Stroke Center: 

  • Catheter angiography available on site 24 hours a day, 7 days a week
  • CT angiography available on site 24 hours a day, 7 days a week
  • MR angiography (MRA) available on site 24 hours a day, 7 days a week
  • MRI, including diffusion-weighted MRI, available on site 24 hours a day, 7 days a week
  • Dedicated neuro-intensive care unit (ICU) beds for complex stroke patients
  • Dedicated neuro-ICU beds for complex stroke patients that include staff and licensed independent practitioners with the expertise and experience to provide neuro-critical care 24 hours a day, 7 days a week
  • Access to neurosurgical services (24 hour availability to a brain surgeon)
  • A physician with expertise in interpreting CT or MRI studies must be available within 20 minutes of being asked to read a study (Telestroke and Interventional Neuroradiologist 24 hour availability)
  • Peer review process to review and monitor the care provided to patients with ischemic stroke, subarachnoid hemorrhage and administration of tPA
  • Participate in Institutional Review Board (IRB)–approved, patient-centered stroke research
  • Specialized diagnostic testing including
    • Transcranial Doppler
    • Carotid duplex ultrasound
    • Extracranial ultrasonography
    • Transesophageal and transthoracic echocardiography
  • Post-hospital care coordination for patients
  • Lab tests, EKG, and CT scan of patients with acute stroke completed within 45 minutes of being ordered
  • The medical organization must have a declared and established commitment for acute stroke care
  • The hospital must have written acute stroke “clinical pathways” or “career maps”
  • An acute stroke team, including a physician and at least one other healthcare professional, must be available around the clock
  • Follow long-term stroke treatment outcomes and design quality improvement activities
  • Emergency staff must have completed formal training in acute stroke treatments
  • The hospital must have a “stroke unit”
  • There must be a designated stroke center director
  • The stroke team must schedule stroke medical education sessions for stroke staff

Quality of Care and Outcomes

AHA/ASA Get With the Guidelines® Stroke Performance Achievement Awards

Get with the Guidelines Gold Plus AwardAllegheny General Hospital was awarded the 2017 American Heart Association/American Stroke Association (AHA/ASA) Get With The Guidelines® Stroke Gold Plus Honor Elite Performance Achievement Award.

This award recognizes our commitment and success in implementing excellent care for in-hospital stroke patients, according to evidence-based guidelines from the American Heart Association/American Stroke Association. The AGH Comprehensive Stroke Center was the first in the region to receive the Gold Award distinction in 2008 and has been recognized annually since then.

Joint Commission and AHA/ASA Get with the Guidelines Reported Performance Measures

  1. Patients with acute stroke who arrive at the hospital within 2 hours and receive IV rt-PA within 3 hours.
  2. Patients with stroke who are not able to walk independently will receive preventative therapies to prevent blood clots in the legs.
  3. Patients with stroke or TIA, and have Atrial Fibrillation or Atrial Flutter will be treated with anticoagulants (blood thinning medication).
  4. Stroke patients or caregivers who smoke will be given information and advice on smoking cessation.
  5. Stroke patients with abnormally elevated LDL (bad form of cholesterol) will be prescribed a statin (cholesterol reducing medication) or their cholesterol medication dosage will be adjusted.
  6. Early testing for swallowing disorders before patients are given food, fluids or medication by mouth.
  7. Stroke patients or their caregivers are educated and/or given educational materials about stroke, risk factors, warning signs of stroke, activation of emergency medical system, need for follow-up after discharge and medications prescribed.
  8. Stroke patients may be assessed for rehabilitation services by a member of the rehabilitation team.
      

Stroke Center of Excellence

The AGH Comprehensive Stroke Center received NeuStrategy’s Stroke Center of Excellence (COE®) Designee award for 2008-2009. According to NeuStrategy, The COE Survey measures self-reported infrastructure to gauge a hospital or healthcare organization's aggregate capabilities to foster high-quality patient care environment.

Pennsylvania Health Care Cost Containment Council (PHC4)

The PHC4 is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of healthcare, and increasing access for all citizens regardless of ability to pay. The Council collects inpatient hospital discharge records each year from hospitals in Pennsylvania. PHC4 reports and data can be found on the Council's website, and in most public libraries throughout the state. Based on the most recently posted data (PHC4 Hospital Performance Report 2015), AGH stroke patients have lower mortality, expected readmission rates, and lower average hospital charges compared with other regional comprehensive stroke centers.

AGH Stroke Center Performance Improvement Program

The Plan, Do, Check and Act Cycle (PDCA) is utilized as the performance improvement model by the AGH Stroke Program. Performance improvement and measurement is focused on areas in which the quality of patient care and safety may be improved and are identified in the medical literature, by certification and accrediting organizations and by the program leadership.
 

Results are reviewed monthly by the Stroke Program Administrative Director, Stroke Unit CRNP and program leadership with variances reviewed in detail. Data is presented quarterly to the multidisciplinary Stroke Steering Committee for further review and analysis, and to the hospital based Regulatory Readiness Committee which reports findings to the hospital Quality Management Committee, which reports to the Board of Directors. The Stroke Leadership Committee meets bi-weekly to monitor and advance the stroke program. This includes:

  • the evaluation of quality improvement initiatives
  • identification of barriers and proposal of solutions with respect to house-wide stroke inpatient and outpatient care
  • development and implementation of new technology and innovation
  • steering the research program

Carotid Endarterectomy Outcomes

Allegheny General Hospital’s Division of Vascular Surgery is recognized for experience and safe outcomes with carotid endarterectomy (CEA) for the prevention of stroke. Carotid endarterectomy is a procedure in which a surgeon makes an incision in the neck overlying the carotid artery — the major blood vessel bringing blood to the brain — and removes fatty deposits that cause stenosis (narrowing) of the artery.

During the past 7 years (2009-2015), AGH vascular surgeons have performed CEAs in 1,056 patients. Patients who have a recently experienced a stroke due to carotid artery stenosis (symptomatic patients) and patients who have not experienced a stroke (asymptomatic patients) due to carotid artery stenosis may undergo CEA to prevent the likelihood of having a future stroke event. Our experience demonstrates excellent outcomes as compared to nationally recognized benchmarks: 

 

  Symptomatic Patients Asymptomatic Patients
AGH Patients (n) 277 775
AGH Stroke or Death Risk 1.1% 1.4%

References

Kernan WN, Ovbiagele B, Black HR, et. al. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke. Stroke. 2014 Jul;45(7):2160-236.

Conditions We Treat

Stroke conditions treated at the AGH Comprehensive Stroke Center:
 

  • Ischemic stroke
  • Hemorrhagic stroke
  • Transient Ischemic Attack (TIA)
  • Carotid stenosis
  • Cardioembolic stroke
  • Lacunar (small vessel disease) stroke
  • Stroke in young adults
  • Intracranial large-vessel occlusive disease
  • Vertebral and carotid artery dissection
  • Central nervous system vasculitis
  • Blood clotting disorders
  • Aortic arch atherosclerosis
  • Cerebral vein thrombosis
     

Diagnosis and Treatment

Diagnosis

The First Critical Hour

If you, your friend or family member suddenly develops one or all of the following symptoms:

Face: Ask the person to smile. Does one side of the face droop?

Arms: Ask the person to raise both arms. Does one arm drift downward?

Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?

Time: If you observe any of these signs, call 911

The ambulance will notify the AGH Emergency Department of the patient’s age, sex, time of stroke onset, along with an estimated arrival time to Emergency Room.

A page is sent to alert the Stroke team of the impending arrival of the stroke patient with the information obtained from the ambulance crew.

On arrival at the AGH Emergency Department, the patient is assessed by the stroke team using the NIH Stroke Scale (NIHSS) (a tool used to measure the severity of the stroke). The stroke team also obtains medical history, reviews medications and completes blood work, EKG and speaks with the person who witnessed the stroke.

A CT scan of the brain is immediately performed and is read by a board-certified neurologist and/or neuroradiologist.

Treatment options for acute stroke are determined by the location, severity of stroke (NIHSS score), type of stroke and the patient’s medical history. Patients with ischemic stroke (clot in a blood vessel) are assessed to determine if they may benefit from intravenous rt-PA (clot buster). Patients may also be considered for procedures performed in Interventional Radiology where an interventional neuroradiologist may attempt to restore normal blood flow in the brain. Catheters are used to deliver clot busting medication directly into the clot and mechanical devices are used to remove blood clots.

A hemorrhagic stroke (blood vessel ruptures causing bleeding into or around the brain) can be due to high blood pressure (especially if untreated) or a brain aneurysm that bursts. Treatment will be determined by the location and severity of the hemorrhage and the bleeding site. The patient may require an urgent surgical procedure performed by neurosurgeons or a catheter-based procedure by Interventional Radiology to stop the bleeding.

If it is determined you have had a Transient Ischemic Attack (TIA), the symptoms may go away before you reach the AGH Emergency Department or shortly after (disappearing within 24 hours). This is a serious warning sign of a stroke. Up to 40% of people who have a TIA will go on to have an actual stroke. Treatment will depend on the cause of the TIA. A CT angiogram or ultrasound of the neck may be ordered to determine if there is a blockage of arteries in the neck or brain. Surgery may be required if a blockage is found. Lifestyle changes such as quitting smoking, low cholesterol diet, exercise, managing your blood pressure and/or diabetes may help reduce your risk of another TIA or stroke. Medication may be ordered to lower your cholesterol, and blood thinner such as aspirin.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking with dosages, as well as any products such as vitamins, minerals or other dietary supplements.

Major Associated Treatments of Ischemic Stroke

Intravenous Recombinant Tissue Plasminogen Activator (IV tPA)

 

 
A patient suffering from acute stroke undergoes intra-arterial stroke therapy.

Activase was approved by the Food and Drug Administration (FDA) for the treatment of acute ischemic stroke in 1996. The drug is infused intravenously over one hour and must be initiated within three hours from onset of stroke symptoms. Well-defined protocols and experience are required to rapidly identify and accurately select patients with acute stroke who are candidates for treatment. The administration of tPA for acute ischemic stroke improves the probability of having little or no residual neurologic disability by 30 percent. The complication rate of symptomatic intracerebral hemorrhage secondary to tPA is 6 percent. Despite this increased risk of bleeding there is no difference in mortality between patients treated with tPA and those who are not treated.

Stroke Therapies

Stroke patients who are ineligible for treatment with IV tPA may benefit from interventional catheter-based treatments that include diagnostic cerebral angiography, carotid angioplasty/stenting, intracranial angioplasty/stenting, intra-arterial administration of thrombolytic drugs and the use of recently FDA-approved catheter devices for mechanical embolectomy. Patients undergo urgent CT perfusion or MR perfusion imaging which are evolving imaging methods that help the stroke team to make decisions about whether a patient may benefit from intra-arterial stroke therapy. These services are provided at specialized tertiary stroke referral centers with experience in acute stroke treatments.

Carotid Angioplasty and Stenting (CAS)

Certain stroke or TIA patients who are determined to have significant stenosis (narrowing) of the carotid artery may benefit from interventional balloon angioplasty and deployment of specialized carotid stents. CAS has been demonstrated to be effective in stroke patients who are considered higher than usual risk for complications from carotid endarterectomy. Clinical trials are underway to determine the safety and benefit of CAS in stroke patients who are not at high risk of complications from carotid endarterectomy.

Carotid Endarterectomy (CEA)

CEA has been proven as an effective preventative surgical treatment for patients with stroke and TIA due to moderate/severe carotid stenosis. Carotid endarterectomy has been demonstrated to be superior to medical treatment in symptomatic patients with carotid stenosis greater than 70 percent. Select patients with symptomatic moderate-grade carotid stenosis and asymptomatic stenosis may also benefit from CEA.

Stroke Units and Organized Stroke Care

Stroke units have been shown to improve outcomes in stroke patients by providing coordinated evidence-based treatments resulting in reduced medical complications (i.e. pneumonia, deep vein thrombosis), early mobilization, improved functional outcomes, and reduced mortality. Care is provided by a dedicated multidisciplinary team including:

  • Stroke neurologists and nurses
  • Physical medicine and rehabilitation physicians
  • Speech and swallow therapists for dysphagia evaluation and treatment
  • Physical and occupational therapy for early mobilization
  • Dietary professionals for nutritional assessment
  • Clinical case managers
     

Our Doctors

 

Stroke Neurology

Ashis H. Tayal, MD - Medical Director, AGH Comprehensive Stroke Center
David G. Wright, MD - Stroke Neurologist
Crystal T. Wong, MD - Stroke Neurologist
Jon Brillman, MD - Chairman Emeritus, Department of Neurology

Interventional Neuroradiology

Andrew Ku, MD - Director of Interventional Neuroradiology
Robert Williams, MD
Eddie Kwan, MD 

Cerebrovascular Neurosurgery

Khaled Aziz, MD, PhD - Director, Division of Complex Intracranial Surgery
Mathew Quigley, MD

Neurocritical Care

Anthony Zikos, MD - Director of Neuroscience Intensive Care Unit
Daniel Shade, MD
Rajashekar Adurty, MD
Omer Bajwa, MD
Anil Singh, MD
Khalid Malik, MD

Vascular Surgery

Satish Muluk, MD - Director of Division of Vascular Surgery
Daniel Benckart, MD
Bart Chess, MD
Dean Healy, MD
 

The AGH Comprehensive Stroke Center Staff
 

  • Board-certified neurologists specializing in stroke
  • Board-certified diagnostic and interventional neuroradiologist
  • Board-certified cerebrovascular neurosurgeons
  • Board-certified neurocritical care physicians
  • Board-certified vascular surgeons
  • Stroke inpatient clinical nurse practitioner
  • Stroke outpatient clinical nurse practitioner
  • Clinical research coordinators
  • Physical medicine and rehabilitation physicians
  • Speech and swallow therapists - dysphagia evaluation and treatment
  • Physical and occupational therapy — early mobilization
  • Dietary — nutrition assessment
  • Clinical case managers
      

Outpatient Stroke Clinic

Patients with a broad range of stroke disorders are evaluated in this dedicated outpatient subspecialty clinic. Patients undergo outpatient diagnostic evaluations, and stroke risk factor management of hypertension, hyperlipidemia and diabetes. Diagnosis and treatment is also provided for vascular dementia, spasticity and stroke-related depression. The stroke clinic also provides continuity of care for stroke patients discharged from AGH and access to clinical research studies in stroke prevention.

To make an appointment:

Telephone: 412.359.8870
Fax: 412.442.2115

Forms to complete prior to your first visit (New Patient Form, Patient Registration and Medical History)

Life’s Simple Seven
(a helpful online Preventative educational tool from the American Stroke Association) 

Directions to the AGH Outpatient Stroke Clinic

490 East North Avenue
Allegheny General Professional Building
Suite 500
Pittsburgh, PA 15212

From the South

  • Take I-79 North to I-279 North.
  • Follow I-279 North across the Fort Duquesne Bridge and take the East Ohio Street Exit (Exit 7C).
  • Follow the ramp and turn left towards I-279 North/East Ohio Street.
  • Turn left onto East Ohio Street and follow to James Street.
  • Turn right onto James Street and follow to East North Avenue
  • Enter the James Street Garage (access to the AGH Professional Building in on the 3rd floor of James Street Garage)
  • Enter the Professional Building and take elevators to the 5th floor.
  • AGH Stroke Clinic is located in Suite 500 on the right as you exit the elevator
     

From the East

  • Take the I-76 Pennsylvania Turnpike Monroeville Exit (Exit 6) and follow I-376 West to Pittsburgh.
  • Take the North Side/Stadiums Exit across Ft. Duquesne Bridge and follow I-279 North.
  • Continue on I-279 North and take the East Ohio Street Exit (Exit 7C).
  • Follow the ramp and turn left towards I-279 North/East Ohio Street.
  • Turn left onto East Ohio Street and follow to James Street.
  • Turn right onto James Street and follow to East North Avenue.
  • Enter the James Street Garage (access to the AGH Professional Building in on the 3rd floor of James Street Garage)
  • Enter the Professional Building and take elevators to the 5th floor.
  • AGH Stroke Clinic is located in Suite 500 on the right as you exit the elevator

 

From the West

  • Take Route 60 to I-279 North toward Pittsburgh.
  • Follow I-279 North and take the East Ohio Street Exit (Exit 7C).
  • Follow the ramp and turn left towards I-279 North/East Ohio Street.
  • Turn left onto East Ohio Street and follow to James Street.
  • Turn right onto James Street and follow to East North Avenue.
  • Enter the James Street Garage (access to the AGH Professional Building in on the 3rd floor of James Street Garage)
  • Enter the Professional Building and take elevators to the 5th floor.
  • AGH Stroke Clinic is located in Suite 500 on the right as you exit the elevator
     

From the Northeast

  • Take Route 8 South to Route 28 South.
  • Take Route 28 South and follow signs to East Ohio Street.
  • Take East Ohio Street to James Street.
  • Turn right onto James Street and follow to East North Avenue.
  • Enter the James Street Garage (access to the AGH Professional Building in on the 3rd floor of James Street Garage)
  • Enter the Professional Building and take elevators to the 5th floor.
  • AGH Stroke Clinic is located in Suite 500 on the right as you exit the elevator
     

From the North

  • Take I-79 South to I-279 South (Exit 72).
  • Take I-279 South to the East Street/Route 28 North Exit (Exit 8B).
  • Turn right onto East North Avenue.
  • Enter the James Street Garage (access to the AGH Professional Building in on the 3rd floor of James Street Garage)
  • Enter the Professional Building and take elevators to the 5th floor.
  • AGH Stroke Clinic is located in Suite 500 on the right as you exit the elevator

 

Clinical Research

What is a clinical trial?

Although there are many definitions of clinical trials, they are generally considered to be biomedical or health-related research studies in human beings that follow a pre-defined protocol.

Why participate in a clinical trial?

Participants in clinical trials can play a more active role in their own healthcare, gain access to new research treatments before they are widely available, and help others by contributing to medical research.

Who can participate in a clinical trial?

All clinical trials have guidelines about who can participate. Using inclusion/exclusion criteria is an important principle of medical research that helps to produce reliable results.

What happens during a clinical trial?

The clinical trial process depends upon what kind of trial is being conducted. The clinical team includes doctors and nurses as well as other healthcare professionals (research team). They check the health of the individual a the beginning of the trial, then give specific instructions for participating in the trial, monitor the participant carefully during the trial, and stay in touch with the participant after the trial is completed.

What is informed consent?

Informed consent is the process of learning the key facts about a clinical trial before deciding whether or not to participate. It is also a continuing process throughout the study to provide information for participants.

How is the safety of a participant protected?

The ethical and legal codes that govern medical practice also apply to clinical trials. In addition, most clinical research is federally regulated with built in safeguards to protect the participants. The trial follows a carefully controlled protocol, a study plan which details what researchers will do in a study.

For further information visit clinicaltrials.gov.

Clinical Trials in Stroke at AGH

AF-Burden - A Prospective Study of the Quantitative Burden and Temporal Relation of Atrial Fibrillation and Stroke

BASE -  Ischemic Care Biomarkers of Acute Stroke Etiology

Navigate-ESUS - New Approach Rivaroxaban Inhibition of Factor Xa in a Global trial vs ASA to Prevent Embolism in Embolic Stroke of Undetermined Source

NEWTON2 - Study of EG-1962 Compared to S/clinical-trials/basetandard of Care Oral Nimodipine in Adults With Aneurysmal Subarachnoid Hemorrhage

 

Active Registries in Stroke at AGH

GLORIA-AF - Global Registry on Long-Term Oral Anti-thrombotic Treatment in Patients with Atrial Fibrillation

 

Acute Stroke Life Support Course

The Acute Stroke Life Support (ASLS) Course is a hands-on course on acute stroke management targeted to the educational needs of Emergency Medical Technicians, paramedics, and emergency department physicians and nurses.   ASLS course participants will receive continuing education credit and learn valuable clinical assessment skills to accurately recognize and provide emergency management of common stroke syndromes. Early and accurate identification of stroke and quicker treatment will reduce the disability associated with stroke. The course uses computer simulations for life-like training. The participants are also taught to use the MEND examination (Miami Emergency Neurologic Deficit) which takes less than 3 minutes to perform. Pre-hospital personnel receiving training will have the tools to convey stroke assessments to receiving emergency department personnel and provide continuity of care for the stroke patient. The ASLS course not only provides the assessment tools for stroke detection, but also provides insight into to the treatment and care of the stroke patients beyond the emergency room.

Patient Resources

Resources to Help Stroke Survivors and Caregivers

Free subscriptions are available for the following magazines:

Community Resources for Stroke Survivors

Regional and National Patient Resources

  • United States Government
    – Social Security Administration’s Ticket to Work Program 800.772.1213
        Facilitates disabled workers employment without loss of Social Security benefits
  • Commonwealth of Pennsylvania
    – Office of Vocational Rehabilitation: 412.392.4950
        Assists people with disabilities to return to work or obtain employment
    – Department of Public Welfare (Disability Services): 1.866.286.3636
        Offers cash assistance, Medicaid, transportation to medical appointments
     

Services for people 60 and above

  • Allegheny County Department of Aging: 412.350.5460

     

Services for people under age 60

  • Maximus: provides services, long-term care and insurance information, 1.877.550.4227 
  • Three Rivers Center for Independent Living: provides community living supports and attendant care, 412.371.7700

     

General Services

  • ACCESS: 412.562.5353
    Provides transportation for elderly and disabled people in Allegheny County.
  • Center for Assistive Technology: 412.647.1325
    Provides wheelchair seating evaluations; drivers training and evaluations; modification/assistive recommendations for car, home and work.
  • Mobility Aides: Stair lifts, wheelchair lifts etc.
    Progressive Mobility: 724.228.4568
    Pittsburgh Mobility: 412.821.9000
  • Driving Assessments: Drive Able: 412.828.1300

     

Resources for Caregivers of Stroke Survivors
Respite Care: Temporary residential care for patients, providing relief for caregivers.

Online Stroke Support and Information Resources

Stroke Support Groups
Stroke survivors and caregivers interact under the coordination of a professional. The groups take part in activities, exercises and socialization with peers.

 

Northside Stroke Support Program
c/o Allen Place Community Services
227 Bonvue St.
Pittsburgh, PA 15214
412.231.1531
Forbes Hospital
2570 Haymaker Rd.
Monroeville, PA 15146
412.915.8193
West Penn Hospital
4800 Friendship Ave.
Pittsburgh, PA 15224
412.915.8193
Plum Senior Community Center
499 Center New Texas Rd.
Plum, PA 15239
412.795.2330
Age Well Pittsburgh
Pittsburgh, PA 15217
412.422.0400
Bethel Park Community Center
Bethel Park, PA 15102
412.851.2910
HealthSouth Harmarville
Pittsburgh, PA 15238
412.828.1300
HealthSouth Sewickley
Sewickley, PA 15143
412.741.9500
Community United Methodist Church
Irwin, PA 15642
724.744.3413
 

For additional resources, please look to community or religious organizations, senior centers, county social services and public health agencies.

Telestroke Service

Goals

  • To provide stroke neurology expertise in the evaluation of stroke patients
  • To bring specialized stroke care to every patient regardless of their geography
  • To shorten the time to administration of intravenous thrombolysis for acute ischemic stroke
  • To provide 24 / 7 / 365 stroke neurology expertise and assist in the assessment and diagnosis of suspected stroke patients
  • To provide advanced interventional treatment to stroke patients

The AGH Telestroke Service fosters partnerships with hospitals in the region that can mutually benefit our patients and our community.

  • Helping hospitals to deliver more effective stroke care
  • Identifying patients who have more severe strokes and may benefit from advanced therapies at a comprehensive stroke center
  • Working closely with neurologists and emergency medicine physicians at your hospital to provide efficient and seamless care in accordance with stroke guidelines and best practices
     

Consult Overview
 

  • Spoke hospital is provided one number to call for Stroke Alerts
  • AGH stroke neurologists will respond within 15 minutes and establish a telemedicine connection.
  • AGH stroke neurologists will observe the patient, speak with the patient, family, and witness, review patient CT scans and will work with the spoke hospital physician to determine optimal patient treatment (including recommendation for intravenous rt-PA).
  • If necessary, patient can be transferred to AGH for further care and have access to Comprehensive Stroke Center services including NeuroCritical care, interventional stroke therapy or neurosurgical evaluation.

AGH neurologists will provide documentation of the consult and recommended treatment. 
 

Signs of a Stroke

If you or a loved one experienced a stroke—the third leading cause of death and the leading cause of disability in the United States—could you identify the warning signs?

A stroke occurs when the brain is deprived of oxygen. This can occur due to a blood vessel blockage (ischemic stroke) or bleeding in the brain when a blood vessel bursts (hemorrhagic stroke).

Symptoms of stroke occur suddenly and can include:

  • confusion
  • difficulty speaking or understanding speech
  • dizziness
  • loss of balance or coordination
  • severe headache without cause
  • sudden numbness or weakness on one or both sides of the face,
  • arms or legs
  • vision problems

     

Seek Help
Dial 911 immediately if someone is exhibiting stroke symptoms, as time is vital for effective treatment. The more time that passes between the onset of symptoms and the beginning of treatment, the more brain tissue that can be lost. This can lead to more extensive recoveries. 

For a referral to a physician who can evaluate your risk of stroke, please call 412.DOCTORS (412.362.8677).

Extending the Window of Opportunity for Stroke Patients

Literally every minute counts when someone is having a stroke. The longer that blood flow to the brain is interrupted, the greater the likelihood that brain cells are deprived of oxygen and vital nutrients and progression to permanent damage. Within a short time brain cells die and without prompt treatment the consequences can be devastating. Over 140,000 Americans die each year from stroke. Many of those who survive may experience long-term weakness, memory loss and/or disability.

“There is a short window of opportunity to successfully treat a stroke,” said Ashish Tayal, MD, stroke neurologist and Director of the Allegheny General Hospital Comprehensive Stroke Center. “For some patients, certain clot-busting therapies must be administered within three hours of the onset of symptoms to reduce or prevent disability, whereas other patients may need immediate surgery or another form of endovascular (catheter-based) intervention,” he said.

If a stroke is caused by a blood clot in the artery of the brain (called an acute ischemic stroke, which occurs in about 80 percent of all strokes), the patient is evaluated for administration of a drug called intravenous tissue plasminogen activator (tPA), which dissolves the blood clot obstructing the blood flow to the brain. Intravenous tPA is also effective when patients start treatment three- to four-and-a-half hours from the onset of a stroke. Unfortunately, intravenous tPA may not always restore blood flow in the brain and not all patients are candidates for treatment and are then evaluated for catheter-based treatments.

Interventional neuroradiologists at Allegheny General Hospital now offer several advanced, minimally invasive procedures to remove blood clots from the brains of patients suffering from an ischemic stroke—up to eight hours after stroke onset.

AGH neuroradiologists are using the Solitaire F and Trevo retrievable stents (stentrievers) to directly remove clots from brain arteries for select patients with the most severe strokes and in patients not eligible for intravenous tPA. Resembling small tubes with mesh-like walls, stentrievers are inserted through specialized catheters that are passed through a vessel in the groin and then carefully guided into the affected brain arteries via angiography. Upon reaching its target, the stentriever device is opened within the clot to instantly restore blood flow and then the clot is retrieved with the device.

In addition, AGH’s neuroradiologists are using the Penumbra System—a specialized catheter that suctions out the blood clot from the vessel. This procedure also is effective for up to an eight-hour period after the onset of stroke.

“Both the stentrievers and the Penumbra System are sophisticated, technically challenging procedures that should be performed only by the most extensively trained neurointerventionalists,” said Andrew Ku, MD, an interventional neuroradiologist in the Division of Neuroradiology at Allegheny General Hospital. “In the hands of an experienced team of physicians, such as those at the Allegheny General Hospital Comprehensive Stroke Center, patients have a much better chance of recovering from a stroke,” he noted.

Founded in 1988, the Allegheny General Hospital Comprehensive Stroke Center is a designated Primary Stroke Center by the Joint Commission. The center provides both inpatient and consultative care for stroke patients throughout western Pennsylvania and is in the lead position to advance stroke care throughout the hospitals of the Allegheny Health Network. Acute stroke care is provided by stroke neurologists (24-hour service) who treat eligible acute stroke patients with tPA and select patients for interventional stroke therapy. Staffed by a highly coordinated, multidisciplinary team of board-certified neurologists, neurosurgeons, and neuro-interventionalists with subspecialty expertise in cerebrovascular disease, the Stroke Center provides comprehensive evaluation, treatment, prevention and rehabilitative services.

In addition to providing care for ischemic strokes, the Comprehensive Stroke Center treats hemorrhagic stroke. This type of stroke occurs when a blood vessel that supplies the brain ruptures and bleeds. When an artery bleeds into the brain, brain cells and tissues do not receive oxygen and nutrients. In addition, pressure builds up in surrounding tissues and irritation and swelling occur. About 13 percent of strokes are caused by hemorrhage.

Through its innovative treatment approaches, the Allegheny General Hospital Comprehensive Stroke Center is making a difference for thousands of people each year. “Every 45 seconds, someone in America is having a stroke, and every three minutes, someone dies of a stroke,” said Dr. Tayal. “Our Stroke Center will help to greatly optimize the chances of survival and recovery.”

To be referred to a specialist at the Allegheny General Hospital Comprehensive Stroke Center, call 412.DOCTORS (412.362.8677).