Stroke Care | Neurovascular Care

• The only Comprehensive Stroke Center in Maine
• 24/7 access to life-saving care for stroke and other acute neurovascular conditions such as aneurysm rupture and intracranial bleeding
• Dedicated neuro intensive care unit and stroke medical unit
• The MaineHealth TeleStroke Network provides urgent evaluations for patients with suspected stroke at eight hospitals in Maine and eastern New Hampshire
• Videoconferencing and digital imaging technology enable remote evaluation of stoke patients and expedited transfers of appropriate patients to Maine Medical Center
• Rapid assessment and administration of clot busting medication (thrombolytic) for patients without contraindications by our acute stroke team
• Individualized testing and treatment plans to provide the patients the best chance at reducing their risk of recurrent stroke
• In-hospital consultation with a physicians trained in stroke rehabilitation and recovery (also called physiatrists)
• Advanced neurovascular procedures such as cerebral thrombectomy
• Availability of physical therapy, occupational therapy and speech language pathologists 7 days a week
• Coordinated care for ongoing rehabilitation with New England Rehabilitation Hospital
• Robust data acquisition and analysis for continuous quality improvement efforts with frequent multidisciplinary meetings focused on providing the best care possible for our patients
   

Conditions Treated

• Arteriovenous malformation (AVM)
• Carotid artery stenosis
• Cerebral aneurysm
• Cerebral or vertebral artery stenosis
• Cervicocephalic arterial dissection
• Hemorrhagic stroke
• Intracranial arteries occlusion
• Ischemic stroke
• Moya-Moya and occlusive vascular disease
• Subarachnoid hemorrhage
• Transient ischemic attack (TIA)

Services

• ECIC bypass
• Emergent clot-busting (thrombolytic) therapy
• Carotid artery angioplasty and stenting
• Carotid endarterectomy
• Cerebral angiography
• Cerebrovascular surgery 
• Cerebral thrombectomy
• Neurocritical care
• Neuro rehab
• Telestroke services

About Cerebral Thrombectomy 

Cerebral Thrombectomy is a recommended option to remove a clot in eligible patients with a large vessel occlusion stroke or LVO. In this procedure, doctors use a wire-cage device called a stent retriever. They thread a catheter through an artery in the groin up to the blocked artery in the brain. The stent opens and grabs the clot. Special suction tubes may also remove the clot.

The procedure:

• Should be done within six hours of onset of acute stroke symptoms
• Can benefit patients under certain conditions if done within 24 hours of onset
• Should include thrombolytic therapy in eligible patients 

About Carotid Artery Stenting

Our vascular specialists use a procedure called angioplasty to widen the carotid arteries and restore blood flow to the brain. For this procedure, a thin tube with a deflated balloon on the end is threaded through a blood vessel in your neck to the narrowed or blocked carotid artery. The balloon is then inflated to push the plaque outward against the wall of the artery. A stent (a small mesh tube) is then put in the artery to support the inner artery wall. The stent also helps prevent the artery from becoming narrowed or blocked again.

The illustration shows the process of carotid artery stenting. Figure A shows an internal carotid artery that has plaque buildup and reduced blood flow. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows a stent being placed in the carotid artery to support the inner artery wall and keep the artery open. Figure C shows normal blood flow restored in the stent-widened artery. The inset image shows a cross-section of the stent-widened artery. Source: https://www.nhlbi.nih.gov/health-topics/carotid-artery-disease

Aboout TransCarotid Artery Revascularization (Tcar)

The Tcar procedure allows balloon angioplasty and stenting to be completed while blood flow is being reversed away from the brain. Doing it this way prevents small pieces of plaque that may come loose during the procedure from entering the brain.

For this procedure, a small cut is made just above the collar bone. A flexible tube is placed into the artery and connected to a medical device to reverse blood flow. The blood is filtered and returned to the brain through a second tube that is put into the femoral vein, near the thigh. After the second stent is placed, blood flow reversal is turned off. Blood flow to the brain starts flowing in its normal direction again.

About Carotid Endarterectomy

Carotid endarterectomy is a surgery that removes plaque (fatty deposits) from the carotid arteries in your neck. Carotid arteries supply blood and oxygen to the front part of our brain. If plaque and other fatty materials block an artery, it slows or blocks the blood flow, and this could lead to a stroke.

Source: https://www.nhlbi.nih.gov/health-topics/carotid-artery-disease

A: The blocked section of the carotid artery is identified. 
B: The artery is opened and the plaque is removed. 
C: The cleaned artery is closed and secured.
 

The best care, when it matters most

As a certified Comprehensive Stroke Center, MHMMCP is the only hospital in Maine equipped with the complete diagnostic technology and treatment capabilities for acute stroke care. We were the first health care facility in Maine to earn distinction as a Comprehensive Stroke Center from the Joint Commission. It means that our stroke program follows national standards and guidelines that can significantly improve outcomes for stroke patients.

Comprehensive Stroke Centers follow these best practices:

• Using a standardized method for delivering care
• Supporting patients’ self-management activities
• Tailoring treatment and intervention to individual needs
• Utilizing stroke specific emergency treatment pathways, protocols, and orders that reflect the most current stroke research and guideline recommendations
• Analyzing and using standard performance measure data to continually improve treatment plans
• Demonstrating use of and compliance with clinical practice guidelines published by the American Heart and American Stroke Associations
• Providing specialized stroke education for all nurses on stroke-dedicated units and emergency department
• Ensuring that patient information is shared appropriately within the healthcare system, while maintaining patient rights, security and privacy

Our program is surveyed every two years by the Joint Commission during a two-day on-site visit from two of their experts. They validate that our program is in compliance with their standards.

MHMMCP earned the Gold Seal of Approval from the Joint Commission for utilizing a standardized method of delivering integrated and coordinated clinical care based on criteria developed in conjunction with the American Stroke Association and the Brain Attack Coalition.

Stroke Survival

Every second counts once acute stroke symptoms begin. That's why we leverage the MaineHealth network of care to ensure that stroke patients across the region are diagnosed and treated as quickly as possible. We also work closely with neuro rehabilitation and skilled nursing centers to make sure they have the information they need to deliver customized care to our patients.

On average, MHMMCP treats 800 – 900 stroke patients annually.

Neuro Rehabilitation

An important part of stroke care is rehabilitation. MHMMCP, MaineHealth Neurology Scarborough and New England Rehabilitation Hospital work closely together to give patients a seamless continuum of care as they recover from a stroke. Learn more about neuro rehab.

Follow-up Care

All stroke patients discharged directly from the hospital to their home will receive a phone call from a stroke nurse within one week. The nurse checks the patient's recovery status and gives additional education and guidance, if needed.

CHARM (CIRARA in Large Hemispheric Infarction Analyzing mRS and Mortality)

MHMMCP is participating in this study to evaluate the efficacy and safety of intravenous glibenclamide (CIRARA^TM) for severe cerebral edema following large hemispheric infarction. 

Learn more.

We take pride in assuring our patients have the best possible support while recovering from a stroke. Our goal is to help our patients understand:

• What caused their stroke
• How to prevent another stroke
• How to recognize signs and symptoms of stroke
• To seek immediate medical help if they think they may be having another stroke

Patient feedback is another important way that we measure our success. All stroke patients are asked to complete a satisfaction survey after discharge and we use this information to continually improve our care standards and patient services.

92% of MHMMCP stroke patients receive comprehensive stroke education prior to going home.

  Patient Outcomes

• 75% of MHMMCP stroke patients are able to return home or go to rehabilitation after their hospital visit.

MHMMCP is included in the Vascular Quality Initiative, a nationwide prospective database used to collect and analyze outcomes of surgical and minimally invasive vascular procedures. Participation in the initiative allows us to collaborate with other institutions to enhance cerebrovascular treatment outcomes and maintain quality reporting.

Carotid Surgical Procedure Outcomes 

MHMMCP - VQI M2S Pathways Database

Carotid Stenting (CAS) and Carotid Endarterectomy (CEA) Outcomes: October 2021-September 2023

• CEA all patients both symptomatic and asymptomatic new stroke rate = 0% (Joint Commission requires < 6%)
• CEA deaths=0
• CAS symptomatic new stroke rate = 1.7% (Joint Commission requires < 6%)
• CAS symptomatic death rate = 4.35% (Joint Commission requires < 6%)
• CAS asymptomatic new stroke rate = 0.7% (Joint Commission requires < 3 %)
• CAS asymptomatic death rate = 0% (Joint Commission requires < 3 %)

*Based on national standards.

Patients: Talk to your primary care physician about a referral to MaineHealth Neurology Scarborough.

Providers: Providers, please review our referral guidelines and call 207-883-1414 to make a patient referral.

• Stroke Guidelines
• TIA Guidelines

MaineHealth providers may refer through EPIC:

• MMP ADULT PED NEURO REF46 - AMB Referral to Neurology