Mount Sinai Queens Cerebrovascular Stroke Center
Stroke is the fifth leading cause of death in the United States and the leading cause of serious long-term disability. It affects about 800,000 people each year. Strokes do not just happen to older adults. Over the past 15 years, younger adults, ages 25 to 54, have experienced a 44 percent rise in stroke occurrence.
That is why Mount Sinai Queens is making sure cutting edge treatment for devastating strokes is available in the borough.
The Challenge of Stroke
The most serious type of stroke is called a large vessel occlusion (LVO). LVO strokes result from a blockage of one of the major arteries in the brain. This type of stroke accounts for only about 20 to 30 percent of all strokes. However, LVO strokes are responsible for about two-thirds of severe disability and three-quarters of stroke mortality.
Fortunately, we have an effective treatment: thrombectomy. When delivered in a timely fashion, thrombectomy can significantly improve your odds of a life-saving, disability-reducing outcome. The Mount Sinai Queens Cerebrovascular Stroke Center leads the way in providing this treatment in the United States.
Ready and Waiting for Potential Stroke Patients
When a patient is identified as having a possible LVO stroke, FDNY-EMS transports the patient to the nearest thrombectomy capable center. Even before arriving at the hospital (see NYC Stroke Systems of Care), the thrombectomy care team is alerted and begins to prepare for the arrival of the patient. Doctors, nurse practitioners, technologists, and other team members prepare for a rapid evaluation of the patient. The radiology team prepares for the patient’s CT scan, and the neurointerventionists are notified to be ready. This ensures that no time is wasted when the patient arrives at the hospital.
Mount Sinai Queens was the first thrombectomy-capable stroke center in Queens. Even today, it is one of only two such centers in the borough. Designed for quality and efficiency, the center serves as a global model for stroke care. World renowned stroke expert J Mocco, MD, Professor and Vice Chair of Neurosurgery at the Icahn School of Medicine at Mount Sinai, and Director of the Cerebrovascular Center at the Mount Sinai Health System, leads the team that designed and developed the facility.
To ensure that stroke care best practices are shared, there is a built-in robust research infrastructure to continually refine, learn, and teach.
Thrombectomy: Providing Effective Treatment
Thrombectomy is a minimally invasive procedure to remove a blood clot from a blood vessel in the brain. The neurointerventionist guides instruments into a very small incision in the groin or wrist. The instruments are guided through the arteries to the clot. Then the clot is extracted using suction or a stent, restoring blood flow to the affected part of the brain.
The sooner the patient receives a thrombectomy, the greater the chances for recovery. Every 45 minutes of delay reduces the chance of a good recovery by 10 percent. Fully 90 percent of patients have a good outcome if they are treated within three hours of the first symptoms of the stroke. That number drops to 40 percent if more than five hours pass.
The Stavros Niarchos Foundation Advanced Thrombectomy Suite
The Stavros Niarchos Foundation Advanced Thrombectomy Suite at Mount Sinai Queens is the first facility in the United States to utilize specially designed equipment to treat stroke in one room on one table.
A CT scan is carried out first, then the table is rotated to perform an angiography. While we’re moving the table, the neurointerventionalist reviews the imaging and the stroke team prepare for the thrombectomy. No time is lost transferring the patient from one location to another.
Medical Treatment for Stroke: Clot-Busting Thrombolytic therapy (tPA)
Before the development of thrombectomy, we treated ischemic stroke, or a stroke caused by a clot, with recombinant tissue plasminogen activator (tPA). This medicine is also called alteplase.
This drug restores blood flow by dissolving the clot causing the stroke. To be effective, tPA treatment must start within three hours of stroke symptom onset. In some cases, we can give tPA up to 4 1/2 hours after symptoms appear. We evaluate our patients to see if this is the case.
Unless there is medical reason not to, we typically provide tPA before thrombectomy.
Stroke Evaluation, Rehabilitation, and Recovery
Rehabilitation is an important part of the recovery process. The goal of a rehabilitation program is to help you become as independent as possible and attain the best possible quality of life. Research has shown recovery is best when a rehabilitation program starts as soon as possible. At Mount Sinai Queens, our rehabilitation team evaluates stroke patients on their first day at the hospital. Our specialists are skilled in providing rehabilitation care that includes physical therapy to help regain as much movement as possible; occupational therapy to assist in everyday tasks and self-care; and speech therapy to improve swallowing and speech challenges. As a stroke patient at Mount Sinai Queens, you receive physical therapy seven days a week.
We offer several types of rehabilitation treatment:
- Physical therapists assist patients in getting in and out of bed, standing, and walking. The many benefits of standing upright include increased circulation, preventing pneumonia and blood clots, and stimulating the nervous system.
- Speech language pathologists assess any impacts the stroke has had on the ability to swallow, speak, and comprehend. They help stroke patients with aphasia, the loss of the ability to understand or express speech. They assist in relearning how to use language or develop alternative means of communication. They also help you improve your ability to swallow. Often after a stroke, doctors order patients to not receive food or drink by mouth. This is called an NPO order. The purpose is to prevent aspiration pneumonia, and ensure that you are able to swallow food and drink safely.
- Occupational therapists help you learn to perform what are called activities of daily living, such as bathing, dressing, and using a toilet.
Our team creates an individualized plan so you develop the problem-solving and social skills to cope with the after-effects of a stroke. Our goal is your independence, confidence, and quality of life.
New York City Stroke Systems of Care
The New York Fire Department’s Emergency Medical Services uses a systematic approach to assess possible stroke patients. It is called NYC Prehospital Protocol and Hospital Destination Decision Making.
FDNY-EMS evaluates and identifies potential large vessel occlusion (LVO) stroke patients and transports those patients directly to thrombectomy-capable stroke centers like Mount Sinai Queens.
The acronym BE FAST is used to help understand whether a person is having a stroke. If two or more of these symptoms are present, a stroke is likely:
- B – Balance loss
- E – Eyesight changes
- F – Face drooping
- A – Arm Weakness
- S – Speech difficulty
- T – Time to call 911!
Large vessel occlusion strokes may include any or all these symptoms, plus:
- Aphasia, or the loss of ability to understand or express speech
- Face, arm, and leg weakness
- Gaze deviation, or abnormal movement of the eyes
- Impaired consciousness, including drowsiness
- Neglect, or lack of awareness or response on one side of the body
- Visual field cut, or visual field loss on the left or right side