University Health System’s Comprehensive Stroke Center

Tuesday, June 28, 2016
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The Joint Commission and American Heart Association/American Stroke Association certifies University Hospital as capable of treating the most complex stroke patients with the most advanced care available.

Stroke is the fifth-leading cause of death in Texas and nationwide, yet it isn’t easy to find a hospital that excels in every aspect of stroke care — from prevention, to treatment of even the most complex patients, to recovery and rehabilitation, to research into new and better therapies.

In March, University Hospital was certified as a comprehensive stroke center by The Joint Commission and the American Heart Association/American Stroke Association — becoming only the third hospital in Texas and one of about 100 hospitals across the country to become Joint Commission certified.

“Earning this advanced certification is incredibly rewarding to the many people here who have worked for years to build one of the leading stroke programs in Texas, and it should be reassuring to the patients and families who come to us for care,” says Lee Birnbaum, MD, Medical Director of the Stroke Center at University Health System and Associate Professor in the Departments of Neurology and Neurosurgery at The University of Texas Health Science Center at San Antonio.

Dr. Birnbaum is a board-certified neurologist trained in minimally invasive stroke procedures. He is part of a team skilled in removing blood clots from the brain and repairing stroke damage, along with endovascular neurosurgeons Ramesh Grandhi, MD, and Jeremiah Johnson, MD. Both Dr. Grandhi and Dr. Johnson are Assistant Professors in the Department of Neurosurgery.

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University Hospital

“We are able to impact patients in a profound manner,” says Dr. Grandhi, who recalled a recent 85-year-old patient with a large clot in her brain that had left her barely able to move or speak. After inserting a catheter through her groin and using a special stent to remove the clot, blood flow returned and her speech and range of motion improved dramatically.

“It’s amazing,” Dr. Grandhi adds. “The key is early detection, for EMS to get them here and get us involved immediately and aggressively.”

An Elite Group of Providers

University Hospital has been named best hospital in the San Antonio area year after year, and sixth best in Texas, by U.S. News & World Report. It became a primary stroke center in 2010, demonstrating excellence in the triage and treatment of stroke patients.

For many patients with ischemic strokes (those caused by blockages), that means rapid treatment with tissue plasminogen activator, or tPA, which can safely limit stroke damage if given within four and a half hours after symptoms begin. Endovascular procedures can extend that window of time in certain types of stroke.

University Hospital rates for using tPA are well above the national average. The program has earned the American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke Gold Plus Quality Achievement Award for its evidence-based approach.

The Joint Commission has only been certifying comprehensive stroke centers since late 2012, after the criteria were established. Comprehensive stroke centers have much more to offer stroke patients — more specialized diagnostic and treatment options, a higher level of competency among staff, a dedicated neuroscience intensive care unit, an active research program, and much more.

As The Joint Commission notes, comprehensive stroke centers are an elite group of providers. As a group they are responsible for setting the national agenda in highly specialized stroke care.

Advanced options for recovery

After the clot is removed or the bleeding stopped, the next step is recovery. And one of key features of the Stroke Center is the 18-bed Neuroscience ICU, located on the eighth floor of University Hospital’s new Sky Tower. It offers around-the-clock supervision by physicians who are board-certified in neurocritical care. That’s unusual, and the hallmark of a first-rate stroke program.

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Ramesh Grandhi, MD, Assistant Professor of Neurosurgery at UT Health Science Center
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An endovascular stroke procedure at University Hospital

Unlike a medical or surgical ICU, the Neuroscience ICU has the expertise and protocols to prioritize treatments that give the brain the best chance of recovery. It cares for the sickest, most fragile vascular patients, who often need the closest monitoring and life support.

“The type of patients we see, many times they look like they have no chance at the beginning,” says Augusto Parra, MD, Medical Director of the Neuroscience ICU. “But with effort and support, many of them have a second chance afterward.”

After a vigorous application process, the program recently received approval for a training fellowship in neurocritical care, and other neurosurgical residents and fellows rotate through the unit.

University Health System’s Stroke Center also operates an outpatient stroke clinic for those patients after discharge who require more follow-up care from the UT Medicine physicians.

Of course, many stroke patients require rehabilitation in order to return to the highest level of recovery possible. And the Reeves Rehabilitation Center offers the most technologically advanced care in the region, in locations throughout the city.

Recovering stroke patients can regain strength and motion through technology such as the Ekso exoskeleton, a kind of wearable robot that helps patients regain strength and movement; the TheraSuit, which improves range of motion, posture, balance and flexibility; the Bioness Foot Drop system, which stimulates the muscles that help with walking; and much more. Physical, occupational, and speech and language therapy are available.

University Health System also has one of the most active stroke support groups in the region. Members meet monthly at the Robert B. Green Campus.

The Next Generation of Treatments

Another hallmark of a comprehensive stroke center is research, and some high-profile stroke research has taken place at UT Health Science Center and University Health System over the years. More than 25 years ago, Robert Hart, MD, and the late David Sherman, MD, both neurology faculty at the UT Health Science Center, led a nationwide study on reducing the risk of stroke in atrial fibrillation patients. That study, which made international headlines at the time, provided evidence that preventive therapy could reduce stroke risk in atrial fibrillation patients and changed clinical practice.

That focus on research continues today.

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Jeremiah Johnson, MD, Assistant Professor of Neurosurgery at UT Health Science Center

“It’s not just standard-of-care medicine available to patients who come here,” Dr. Birnbaum says. “There are more possibilities of treatment and options for treatment based on our research programs.”

Today, among the studies taking place is MISTIE, an international clinical trial looking at improving the odds for patients with intracerebral hemorrhage, or sudden bleeding into the brain — a condition with few treatment options. The latest phase of MISTIE combines minimally invasive surgery plus medication. The local arm of the study is led by Jean-Louis Caron, MD, Professor of Neurosurgery at UT Health Science Center.

Another research project is looking at the use of an existing drug to control bleeding, aminocaproic acid, sold under the brand name Amicar, to treat patients with intracerebral hemorrhage. Réza Behrouz, DO, Associate Professor of Neurology, and Vivek Misra, MD, Assistant Professor of Neurology, lead that study.

Rounding Out a High-level Stroke Program

Prevention and community education are a large part of University Health System’s stroke program. During April, a campaign was launched to spread awareness of stroke symptoms and the need for urgency — F.A.S.T., or Facial droop, Arm weakness, slurred Speech and Time critical.

That awareness extends to every University Health System employee, from clinical staff to administrators, who have a card attached to their ID badge listing the F.A.S.T. symptoms and the internal phone number to trigger a Stroke Alert (the public is advised to dial 911).

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Lee Birnbaum, MD, Medical Director of the Stroke Center at University Hospital; Associate Professor of Neurology and Neurosurgery at UT Health Science Center

Dr. Birnbaum believes another aspect of University Hospital’s Stroke Center is an important — if less appreciated — piece that adds to the excellent stroke care that patients get. That’s the hospital’s academic mission to train the next generation of physicians and providers.

“We not only have the attending physician, but also an ACGME (Accreditation Council for Graduate Medical Education)-accredited vascular neurology fellowship, an ACGME-accredited neurology residency and ACGME-accredited neurosurgery residency,” Dr. Birnbaum says. “That creates an environment of curiosity and discussion — along with several layers of vigilance — so that patients receive more attention and more careful exploration of their medical problem and treatment plan.”


For more information about the Stroke Center at University Health System, visit universityhealthsystem.com/services/neuroscience or call 210-358-8555.