The most advanced stroke treatments and equipment in the world won’t make a difference in an environment that can’t support their use.
Fortunately, the University of Michigan’s Comprehensive Stroke Center can meet stroke head on. Accredited by the Joint Commission, all physicians are board certified. And as they offer care for patients—from straightforward conditions through the most complex cases—they have the latest technologies readily available.
“Our teams of physicians, nurses and therapists are set up to ensure all of our patients receive the highest level of care, from their emergency department (ED) stay until their discharge,” says neurologist Eric E. Adelman, M.D. Adelman co-leads the Center with neurosurgeon Aditya S. Pandey, M.D., and emergency medicine physician William Meurer, M.D.
“We have a strong focus on quality improvement and continually work to improve the care we provide.” The Center treats patients before, during and after stroke, through preventive, emergent and rehabilitative care, and can accept new patients at any point throughout the care continuum.
Patients at U-M are treated by a multidisciplinary team of emergency medicine, neurology, neurosurgery and neurointerventional radiology physicians who are specially trained in stroke care. Vascular surgeons, cardiologists, internal medicine and physical medicine and rehabilitation physicians are also part of the care team.
The Center always keeps in mind that just as no two strokes are the same, neither are any two patients the same.
“Our goal is to design a team specific to the patient and disease,” says Aditya Pandey, M.D.
Cerebral aneurysms and AVMs can also cause significant neurological disability and even death, and U-M has a multidisciplinary approach to treating such individuals with such difficult conditions as well.
“Our radiologists and neurosurgeons use the latest techniques in providing cutting-edge treatments in the safest manner. We have three dual trained cerebrovascular neurosurgeons who treat diseases with both minimally invasive endovascular techniques as well as open microsurgery techniques,” Pandey says.
After any type of stroke procedure, patients go to either the Stroke Unit or the Neuro ICU. “Our state-of-the-art Stroke Unit and Neuro ICU ensure that patients can be safely monitored by nursing staff and have ready access to rehabilitation,” Adelman says.
Clot-busting Stent Retrievers
In one of Michigan’s unique surgical rooms, a CT scan of the head can be performed in the same room where doctors can remove clots from vessels or repair brain aneurysms, saving critical time for the stroke patient.
“Here, we are able to use neurointerventional radiology to enable endovascular image-guided treatment of brain aneurysms, brain bleeds and opening of blocked brain vessels,” says Neeraj Chaudhary, M.D., MRCS, FRCR. “Our endovascular practitioners are extremely well-trained in the use of all the state-of-the-art medical devices. And their expertise is supported by a robust setup of regular monitoring of clinical outcomes to ensure the best for our patients.”
Among the newest generation devices are stent retrievers. They resemble the wire stents often used to keep coronary arteries open but function more like a trap. When a catheter containing a collapsed stent retriever reaches a clot blocking a cerebral artery, the stent moves out of the catheter, unfolds to form a 3-D mesh tube, ensnares the clot and retracts back into the catheter with its catch. Surgeons then thread the catheter with the clot back out of the body.
In the meantime, the artery is cleared and blood flows back into the brain, replenishing its vital supply of oxygen and glucose.
Neurosurgical Intensive Care Unit (NICU)
The Neuro ICU is a 15-bed unit that cares for critically ill neurosurgery and neurology patients, including stroke patients. The unit is led by neurointensivist Venkatakrishna Rajajee, MBBS, and staffed by four board-certified neurointensivists, which is relatively rare.
“We add value in different ways,” says Rajajee. “For the neurosurgery patient, the Neuro ICU allows particularly high-risk, complicated procedures to be performed. Yes, you know you can provide treatment and surgery, but you want to be certain that there is the ability to provide care afterwards if there are complications. You want the ability to monitor the patient extremely closely afterwards. You can lose all the benefits from the surgery if you don’t have the ability to provide the care afterwards.”
Stroke Rehabilitation—Individualized Treatment Plans
Rehabilitation Physician Edward S. Claflin, M.D., leads the U-M Acute Stroke Rehabilitation Program for patients who have significant disabilities because of stroke.
Once again, state-of-the-art equipment and technologies—such as the Lokomat robotic exoskeleton, BioEx gait training with biofeedback, Bioness technologies, Saebo hand and foot functional tone management, graded UE biking, and neuromuscular and functional electric stimulation—are backed up by the knowledge and expertise of a truly interdisciplinary and collaborative team.
Their team of experts includes a physical medicine and rehabilitation physician (a physiatrist), physical therapists, occupational therapists, speech language pathologists, neuropsychologists, rehab engineers, exercise technicians/personal trainers, orthotists/prothetists and a case manager.
“The medical or surgical team asks for rehabilitation assessments by therapists as soon as it is deemed safe—usually within hours of a patient’s admission. These therapists will continue to see patients in the hospital until they move to the next level of rehab,” says Claflin. After assessment, the team develops specific rehab goals and a timeline for transitioning to another rehab setting or back home. The team even develops home exercise plans so that patients can maintain their level of function.
“Our goal is to help patients achieve their best level of function after stroke,” Claflin says.
“A truly comprehensive stroke care setup cannot function unless there is genuine collaboration among its different components,” says Chaudhary. “Here at the University of Michigan, all the components of such a comprehensive stroke center work in perfect harmony.”
“We appreciate the privilege of treating all of these patients and appreciate each referring physician’s important contribution in allowing us these opportunities,” Pandey says.