Surviving Stroke
“More than 20 hospitals across the state refer their stroke patients to Overlook, where patients have access to the most advanced treatment options.”

Shalini Bansil, MD, medical director of the Stroke Program at Overlook Hospital, is quick to the point when she says this, because she wants people to understand—without question—the severity of stroke. It is, in fact, the third leading cause of death in the United States and the No. 1 cause of disability among adults. Lack of oxygen in the brain, caused by stroke, often results in diminished capacity for speech, memory, or movement. For those who survive and go on to thrive, the time to treatment—and the treatment a patient receives—is what makes the difference.

Understanding and Treating Stroke

A stroke occurs when blood supply to the brain is interrupted due to a blood clot (an ischemic stroke), or when there is bleeding in the brain (a hemorrhagic stroke) caused by a ruptured blood vessel. Either can be fatal. Symptoms of stroke include speech problems (slurring words, difficulty speaking, trouble acquiring the right words to say or difficulty understanding speech), blurred vision, weakness or numbness on one side, a sudden severe headache, or problems with balance or gait. Any one of these warning signs—especially of it comes on suddenly—could be signaling a stroke. “If you notice any of these things, time is of the essence,” says Bansil. “You need to get to a designated stroke center ASAP.”

The Stroke Center at Overlook, awarded the Gold Seal of Approval from The Joint Commission for Primary Stroke Centers, was the first site in the state to be designated a Comprehensive Stroke Center by the New Jersey Department of Health and Senior Services. The Stroke Center is a core component of the Atlantic Neuroscience Institute. Here patients are provided with diagnoses and treatment. A “Code Gray” rapid-response group of neurologists, neurosurgeons, nurses, and radiologists is on hand to diagnose and treat stroke patients 24 hours a day, seven days a week.

Many patients, suspected of having a stroke, will enter into the Stroke Center through the Overlook Emergency Department. Doctors will perform a physical assessment, and a CT scan of the brain is used to confirm diagnosis and determine which type of stroke has occurred.

If you think you or someone you’re with may have had a stroke, make note of the time that you first noticed symptoms; this can actually help to determine the course of treatment. More than 20 hospitals across the state refer their stroke patients to Overlook, where patients have access to the most advanced treatment options.
tPA: The predominant treatment for ischemic stroke is tPA (tissue plasminogen activator), a powerful drug administered intravenously to break up the clot that has caused the stroke. Recently, the guidelines for using tPA were adjusted. “We always thought tPA to be effective up to three hours,” explains Bansil, “but that has been expanded up to 4.5 hours.” Beyond that window of time, tPA can be dangerous.

Merci Retrieval System: This mechanical method of clot retrieval is available in very few hospitals in the United States, but it was introduced at Overlook three years ago and can be used up to eight hours following the onset of stroke. The Retrieval System is made up of three components: the Merci Retriever, Merci Microcatheter, and the Merci Balloon Guide Catheter. Once the location of a clot has been identified through the use of angiography, the Merci Balloon Guide is inserted through a small incision in the femoral artery in the groin. Using X-ray images as a digital roadmap, the Balloon Guide is maneuvered through a maze of blood vessels and into the brain. A guidewire and the Merci Microcatheter are deployed through the Balloon Guide and placed just beyond the clot. The physician then deploys the Merci Retriever—a flexible wire that curls into a corkscrew—to ensnare the clot. Once the clot is captured, the Merci Balloon Guide Catheter is inflated to temporarily stop blood flow forward while the clot is being withdrawn. The clot is drawn into the Merci Balloon Guide Catheter and pulled out of the body. The balloon is then deflated, and blood flow is restored.

Penumbra: This device works similarly to the Merci System but utilizes suction to remove a clot.
With so many treatment options, Overlook has achieved one of the highest rates of stroke intervention.

Protecting Yourself From Stroke

The National Stroke Association estimates that as many as 70 percent of strokes are preventable when people follow common-sense suggestions for living a healthy life. Bansil recommends controlling blood pressure, decreasing cholesterol levels, and increasing exercise. “Obese people tend to be at higher risk,” she says. “Sedentary people are at higher risk—but weight loss and exercise tend to decrease blood pressure and indirectly decrease risk of stroke.” Bansil also cautions people against smoking—“Your risk of hemorrhage from an aneurysm may be increased,” she says—and notes that diabetes, if a factor, should be brought under control.

“Patients are living to an older age, and as you get older the risk of stroke becomes greater,” says Bansil. “But simple lifestyle changes really do make a difference.”

For more information on the Atlantic Neuroscience Institute or the Stroke Center at Overlook Hospital,
call 866-631-8221.