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Treatment and Therapies

The Advanced Care for Stroke Symptoms You Need, Close to Home

The effectiveness of any stroke therapy depends on how quickly you recognize the symptoms and seek emergency medical care. Illinois law mandates that any patient believed to be suffering from stroke symptoms must be transported to the closest Primary Stroke Center.

Northwest Community Hospital, as a Primary Stroke Center, is one of only two hospitals in the Northwest Suburbs able to offer two of the most advanced, highly effective interventions for signs of a stroke.

Once NCH’s stroke team determines the type of stroke you have suffered, they will then select the most effective treatment for you.

NCH’s new stroke intervention procedures for ischemic strokes

If your condition is appropriate, the following interventions will be provided to you:

  • Within the first 4.5 hours: Since ischemic strokes are caused by blood clots, NCH’s medical team will administer a clot-busting drug such as tPA (tissue plasminogen activator) intravenously.
  • Up to eight hours after the onset of stroke symptoms: If the IV treatment does not adequately dissolve the clot or it cannot be administered effectively within the time frame, minimally invasive neurointerventional techniques (intra-arterial thrombolysis, or reaching the clot by navigating through an artery) may be used to locate, dissolve or remove your clot.
Before Treatment   During Treatment   After Treatment

Before treatment. Many more branches of the artery should be seen, but because blood flow is blocked, those arteries are not visible.

 

During treatment. The patient is given tPA (medication) and the penumbra device is used to clear the blockage. In this image, more artery branches are becoming visible.

 

After treatment. The clots have been removed from the basilar artery. Many more artery branches are now visible.

For more information on interventional radiology, click here.

We offer treatment options for many other neurological disorders, including:

Aneurysm coiling

A minimally invasive or endovascular technique for treating aneurysms, coiling is performed by NCH’s neurointerventionalists. Unlike open surgery, this procedure addresses the problem from inside the blood vessel by blocking blood flow to the aneurysm and decreasing the risk of a rupture.

This technique involves inserting a catheter (a thin tube) into the femoral artery located in the patient’s leg, near the groin area, and guiding it up to the site of the aneurysm in the head. The catheter provides the pathway for the insertion of detachable platinum coils; their job is to pack and block off blood flow to the bulging and weakened arterial wall. The flexibility of the coils—visible under X-ray due to the platinum—allows them to conform to the balloon shape of the aneurysm. This technique, performed under general anesthesia or moderate sedation, effectively prevents the aneurysm from bursting. Patients usually spend one to two days in the hospital and may be placed on blood thinners, such as aspirin, after the procedure.

Condition

Aneurysm coiling is an appropriate treatment for the following condition:

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AVM embolization

AVM embolization works from within the blood vessel to block the blood supply to the vessels of the malformation and decrease the risk of rupture. A minimally invasive or endovascular technique, AVM embolization is performed by NCH’s neurointerventionalists.

This technique, performed under general anesthesia or moderate sedation, involves inserting a catheter (a thin tube) into the femoral artery located in the patient’s leg, near the groin area, and guiding it into the arteries in the neck. A microcatheter follows the same route and, under X-ray guidance, is guided directly to the AVM, which is used to inject embolic material to permanently block and seal off the AVM. Embolization can help to shrink the AVM, making further treatment such as surgery or radiosurgery safer and easier to tolerate for the patient. In some cases, embolization may entirely take care of the AVM, which may require no further treatment.

Condition

AVM embolization is an appropriate treatment option for the following condition:

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Carotid and vertebral artery stenting

Stenting is a minimally invasive, non-surgical technique for opening narrowed blood vessels of the brain, as in the case of artery dissections or narrowing from plaque in the walls of the artery. Performed by NCH’s neurosciences team, this procedure uses a catheter-based system to shore up the walls of the narrowed artery.

This technique, performed under moderate sedation or general anesthesia, involves inserting a catheter (a thin tube) into the femoral artery located in the patient’s leg, near the groin area. Threading the catheter up to the carotid and/or vertebral artery with the use of X-ray guidance, the neurointerventional specialist carefully navigates a small plastic tube (catheter) into the real lumen of the dissected artery. A tiny wire cylinder called a stent is placed in the space and works as permanent “scaffolding” to prevent the artery from narrowing or closing again. Narrowing due to atherosclerosis or plaque is treated in the same manner if it is thought to represent a danger of stroke (brain attack) to the patient.

Condition

Carotid and vertebral artery stenting is an appropriate treatment for the following conditions:

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Embolization

Embolization is a minimally invasive treatment designed to completely or significantly reduce the blood flow to a lesion, either to cure it completely or prior to removal of the lesion. When done pre-operatively, embolization helps to reduce the complications that may occur from bleeding by working from within the blood vessel to block blood supply.

This technique, performed while the patient is under moderate sedation or general anesthesia, involves inserting a catheter (a thin tube) into the femoral artery located in the patient’s leg, near the groin area, and guiding it directly to the blood vessels supplying the lesion. A microcatheter follows the same route and, under X-ray guidance, is used to inject embolic material to permanently block and seal off the vessels involved.

Conditions

Pre-operative embolization is performed for the following conditions:

Embolization can also work as a curative treatment in the following conditions:

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Intracranial angioplasty and stenting

Intracranial angioplasty and stenting is a minimally invasive way to open up very narrowed arteries inside the skull that supply the brain. When the narrowing of the artery is significant (greater then 70 percent decrease in diameter) or if the narrowing is causing symptoms (strokes or mini-strokes) despite medical treatment, then intracranial angioplasty with or without stenting is recommended.

What is angioplasty?
When a small balloon is used to slowly open up an artery that is narrowed by “plaque” (artherosclerosis), the procedure is called an angioplasty.

What is stenting?
A stent is a small metal mesh tube that is used to buttress the walls of the narrowed artery. It is often used in conjunction with angioplasty.

How is it done?
The doctor places a small plastic tube (catheter) through the artery in the groin and guides it, using X-ray guidance, into the arteries in the neck. After taking pictures of the artery of interest and measuring the length of the narrowed part of the artery, the doctor will choose the correct size of balloon or stent to use. The balloon and/or stent is then delivered carefully under X-ray guidance to the area of narrowing and used to open up the artery.

What is the success rate?
The technical success rate is greater than 95 percent.

What are the risks of treatment?
The risk rate of the procedure ranges from 3–10 percent depending upon the overall medical condition, the patient location of the narrowing and other facts unique to each patient. The doctor will carefully weigh the risk of the disease against the risk of the procedure. If the risk of the disease outweighs the risks of the procedure, then the procedure is recommended. Our doctors go over the risks and natural history of each patient’s disease and the benefits and risks of treatment with each patient in detail. Each patient is unique and deserves an in-depth analysis and discussion of their condition.

Condition

Intracranial angioplasty and stenting is an appropriate treatment for the following conditions:

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Kyphoplasty

Kyphoplasty, also a minimally invasive procedure, involves the insertion of a needle into the fractured vertebra under X-ray guidance. Through the needle, a balloon is inflated to raise the fractured “roof” of the vertebra and create space within the crushed bone tissue “decompressing” the area.

The resulting cavity is then filled with surgical cement to stabilize and strengthen the fracture. As with vertebroplasty, patients are under local anesthesia throughout the procedure and go home with bandages placed over the incision sites.

Condition

Kyphoplasty is an appropriate treatment for the following condition:

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Stenting

The main objective in treating traumatic vascular lesions is to prevent or eliminate intracranial bleeding. NCH’s neurosciences team uses stenting and/or occlusion to block off holes in the damaged blood vessel(s). Neurointerventionists perform the procedure by using a minimally invasive or endovascular approach.

This technique, performed under general anesthesia or conscious sedation, involves inserting a catheter (a thin tube) into the femoral artery located in the patient’s leg, near the groin area, and guiding it directly to the damaged blood vessel(s) in the head or neck. If the doctor determines that the safest treatment is to close the damaged vessel, a microcatheter follows the same route and, under X-ray guidance, is used to inject embolic material to close or occlude the opening. If a clot has formed around a hole in a main artery or the artery is abnormally narrowed due to the injury, the neurosciences team may insert a stent—a wire mesh cylinder—through the catheter to shore up the walls of the vessel. Once stenting has opened the artery, it allows for the injection of occluding material to completely close the hole in the wall of the artery. “Covered” stents, which are wire mesh tubes with an enclosed cover, are an elegant solution to repairing a torn blood vessel.

Conditions

Stenting is an appropriate treatment for the following conditions:

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Stroke therapy

Time is of the essence when diagnosing and treating a stroke (brain attack) and restoring normal blood flow to the affected areas. The success and effectiveness of interventional stroke therapy literally depends on how quickly a patient recognizes the symptoms of stroke and seeks emergency medical care. Interdisciplinary in nature, NCH’s neurosciences team works seamlessly with the emergency room, vascular neurology and other specialists to determine the type of stroke a patient is experiencing and select the most effective treatment option for that individual.

For ischemic strokes caused by blood clots, the medical team will first give clot-busting drugs, such as tPA (tissue plasminogen activator), intravenously to patients who arrive at the hospital within three hours from the onset of stroke symptoms. If the tPA does not adequately dissolve the clot or cannot be administered within the ideal time frame, NCH’s neurosciences experts can offer intra-arterial (through the artery) thrombolysis treatment. This therapy helps extend the required treatment time for tPA up to six hours by delivering the clot-busting drug directly to the blockage. This intra-arterial procedure involves inserting, under X-ray guidance, a catheter (a thin tube) into the femoral artery located in the patient’s leg, near the groin area, and guiding it to the site of the clot. From there, the interventional neuroradiology team can locally administer a clot-busting agent to dissolve the blockage. The patient undergoes the entire procedure under general anesthesia.

Clots can also be broken up or removed via mechanical means. Using the same type of catheter-based technique as other intra-arterial therapies, NCH’s interventional neuroradiologists have many advanced clot-retrieving systems for the treatment of ischemic stroke at their disposal. Inserted through the catheter, a tiny corkscrew-shaped device, called the MERCI, allows the neurosciences specialists to capture the clot and pull it free and away from the site of the blockage. This procedure can be used up to eight hours after the onset of stroke symptoms.

Learn more about our award-winning stroke program.

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Vertebroplasty

Vertebroplasty, a minimally invasive procedure developed by neuroradiologists, helps to stabilize spinal fractures and relieve associated pain. Performed by NCH’s neurosciences team, the procedure involves the insertion of one or two needles through the skin and into the fractured vertebra under X-ray guidance.

Surgical cement is then injected into the fractured vertebra to stabilize the damaged bone. Used in hip and knee replacements, the cement strengthens the fracture and can induce new bone growth. Patients are under local anesthesia throughout the procedure, with some mild sedation and pain control also provided for maximum possible comfort. No stitches are required and most patients go home on the same day.

Condition

Vertebroplasty is an appropriate treatment for the following condition:

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Get the best in neurological care. For a physician referral, call HealthConnection at 847.618.4YOU (4968), or find a physician here.

Healthcare providers: For emergency or urgent intra-hospital transfers, please call our 24-hour Stroke Hotline at 847.618.8888.

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Last Updated 04/10/2009