The Stroke Service is staffed by a team of neurologists with subspecialty expertise in this area.As a result of their clinical experience and research efforts, we have experience in diagnosing and managing a spectrum of disease, from "common" stroke to the rarest of cerebrovascular conditions, such as cerebral amyloid angiopathy.
The physician faculty of the Mass General Stroke Service care for patients with complex cerebrovascular disease, in all phases of care from prevention to acute intervention and recovery. They care for strokes of all types, including ischemic and hemorrhagic stroke, and due to a variety of causes such as atherosclerosis, infection, vasculopathy, inherited disorders and other rare causes. A comprehensive approach to care addresses the needs of young adults through the very old, with clinical and research collaborations across numerous Divisions and Departments, the Mass General Vascular Center, primary care practices and the Spaulding Rehabilitation Network. The faculty of Critical Care and Emergency Neurology Division also hold appointments in the Stroke Service, and together through this collaborative partnership the Division delivers acute inpatient care under the Acute Stroke Service led by Dr. Rost, the C. Miller Fisher (CMF) inpatient vascular neurology service and Stroke Consult Service led by Dr. Silverman, and the TeleStroke Service led by Dr. Viswanathan which extends our stroke expertise to over 30 emergency departments in New England.
The Mass General Stroke Service, founded by Dr. C Miller Fisher in the 1950s, is one of the oldest of its kind in the US, and carries forward a tradition of clinical and research excellence focused on improving the diagnosis and treatment of every patient it cares for, and preventing recurrent stroke whenever possible. Stroke Service faculty are nationally recognized leaders in the field of stroke who have guided the development of the field for decades, and hold multiple foundation, and R01 and U01 federal grants across a wide spectrum of topics from disease biology to translational therapeutics.
Research Programs within the Stroke Service
The 22 faculty members of the Stroke Service conduct funded research across the full spectrum of translational research as depicted below, under the overall guidance of Dr. Steven Greenberg who serves as the Research Integration Liaison for the Stroke Service and the site PI for the NINDS funded National NeuroNext and SPOTRIAS networks, while Dr. Schwamm serves as the site PI of the Regional Coordinating Center for Massachusetts in the newly launched NINDS StrokeNet Network.
Shifting the Neuroendovascular Care Paradigm
Mass General was an early pioneer in the field of neuroendovascular care, and a strong advocate of the value of interdisciplinary care, with neurology, neurosurgery and neuroradiology faculty all working together to achieve the best patient outcomes. “The neuroendovascular field was once dominated by radiology. It has undergone a major paradigm shift in the last few decades and the Mass General Neuroendovascular faculty now includes physicians from neurology, neuroradiology and neurosurgery and trains fellows from all three disciplines. We’ve created a collaborative environment which promotes thoughtful, evidence-driven, and truly patient-centered care,” says Dr. Leslie-Mazwi, Director of Interventional Neurology in the Neuroendovascular program.
The neuroendovascular team meets weekly to discuss challenging patients with other physicians that deal with cerebrovascular disease, including Neurosurgery, Radiation Oncology, the Stroke Service and NeuroCritical Care, and decides as a group on the best treatment options for each patient. “Every patient's problems, risk factors and social situations are so individual. Treatment should be individually tailored to best meet their needs and expectations” says Dr. Leslie-Mazwi. Team members often observe or participate jointly in each other's procedures to ensure the maximum benefit of experience and collaboration, and to facilitate an evidence-based approach to adopting new and emerging technology.
Using CT Angiography and MRI to Assess Ischemic Stroke Patients
Determining which ischemic stroke patients will benefit most from which therapy is a challenge. ”Every patient who is eligible should receive the clot-buster drug IV tPA, but a percentage of these patients with major strokes will require an endovascular procedure to snare and extract the clot directly,” says Dr. Leslie-Mazwi. Mass General pioneered novel, non-invasive CT-based imaging methods to detect blockages in brain arteries and MRI to quantify the amount of brain tissue that is irreversibly injured during a stroke, and these techniques are now the standard of care used around the world. Mass General researchers helped to define the parameters that can identify patients who are disabled enough to warrant treatment but are still safe to treat with advanced techniques of blood clot extraction. “Our research has shown that patients with less than 70 cc of brain damage can make a good recovery. However, patients with more extensive damage rarely have a good outcome even if we are able to open the blocked blood vessel,” Dr. Leslie-Mazwi says.
Extending the Reach to Improve Stroke Care Across the Northeast
Mass General neurologists have also been leaders in developing methods for measuring and improving the quality of stroke care across the US, and for increasing the proportion of patients who can receive the clot-buster drug IV tPA. Through the world-renowned Mass General TeleStroke Network which was established in 2001, the Mass General Stroke Service can now extend its acute stroke expertise to serve a catchment area of 6 million patients presenting to over 30 emergency departments across the northeast 24 hours a day, seven days a week. “Time is brain,” says Dr. Leslie-Mazwi. “By partnering with spoke hospitals, Telestroke enables us all to accelerate treatment and save lives.”
Through cutting edge research, superb clinical training and outstanding clinical care, the Mass General Stroke Service continues the tradition begun by Dr. Fisher over 65 years ago with the ultimate goal of reducing the incidence and burden of stroke.
What to Expect
Patients with stroke symptoms are often transported to the emergency department for evaluation. Neurologists examine the patient in the emergency department and tests (including blood tests, brain scans, and heart monitoring) are performed to pinpoint the cause of the symptoms and determine whether clot-busting therapies are appropriate.
Many patients come to our program after being evaluated via TeleStroke and treated at a community hospital. Once they arrive at Mass General, they are evaluated by a stroke specialist, considered for an acute interventional procedure and admitted to the Neuroscience Intensive Care Unit.
Patients typically remain in the hospital for several days to complete diagnostic testing, establish a cause for the stroke and begin secondary prevention therapies. If neurological problems persist, patients are referred for acute inpatient rehabilitation.
Managing the Full Spectrum of Stroke
The Stroke Service is staffed by a team of neurologists with subspecialty expertise in this area. As a result of their clinical experience and research efforts, we have experience in diagnosing and managing a spectrum of disease, from "common" stroke to the rarest of cerebrovascular conditions, such as cerebral amyloid angiopathy.
Over the past 15 years, we have undertaken a number of important initiatives to improve the quality of stroke care. We have created standardized approaches (or "pathways") that reduce the time for diagnosis and treatment while enhancing patient outcomes. Our Acute Stroke Program serves as a blueprint for other centers in the United States and abroad. And we were among the first centers to develop an evidence-based Stroke Prevention Clinic to ensure patients receive optimal protection to avoid a stroke.
We have also pioneered efforts to prevent post-stroke aspiration pneumonia. This condition, which complicates 10 to 20 percent of stroke cases, makes swallowing very difficult and can lead to death by choking. Working with the Mass General Department of Speech, Language and Swallowing Disorders, we have developed a more aggressive approach to screening patients for aspiration pneumonia. Our model has been adopted by hospitals nationwide, saving lives in the process.
Streamlining Diagnosis & Treatment
Patients with stroke often suffer from other vascular diseases or disorders as well. So where appropriate, Stroke Service neurologists can call on the world-class expertise of the many specialists within the Mass General Vascular Center. Our multidisciplinary approach to patient care (a rarity in stroke centers) greatly streamlines the diagnosis and treatment of patients with complicated vascular disorders or cardioembolic stroke.
Finally, the Stroke Service has always been committed to advancing the understanding and treatment of cerebrovascular disease. Through our training programs, we educate our medical students, residents, fellows, physicians, nurses and administrative staff, as well as observers from other institutions. Our approach fosters in-depth discussion and analysis of cases and promotes state-of-the-art clinical management.