Stroke is third leading cause of death among Americans. MedStar Georgetown University Hospital excels in the diagnosis and treatment of the range of neurovascular conditions that increase your risk of developing stroke, including arterial dissection and Moyamoya disease.
Emergency Stroke Treatment
When stroke occurs, every minute matters. The stroke team in our award-winning Neurocritical ICU leads the region in treating acute stroke and accepts patient transfers from other hospitals in the mid-Atlantic region. Our integrated stroke team includes board-certified neurointensivists and nationally-recognized nurses skilled in the use of critical care pathways for the rapid diagnosis and treatment of stroke, preventing lasting brain damage and reducing the risk of death.
There are two major types of stroke, each requiring different treatment approaches:
- Ischemic stroke is caused by formation of a blood clot, blocking an artery that supplies the brain with blood. When blood flow is disrupted, the affected part of the brain can no longer function and can be permanently damaged. Ischemic stroke accounts for about 80 percent of all strokes.
- Hemorrhagic stroke occurs when a blood vessel bursts and forces blood into the brain tissue. The mass of blood interrupts brain function and can cause permanent brain damage.
Strokes can respond to medications that bust up clots or reduce swelling, but there is a critical window of time after stroke onset during which medication-based treatment is effective. For some patients, surgical clot removal or blood vessel repair may be required to restore blood flow and prevent brain damage or death.
Learn more about acute stroke intervention and treatment at MedStar Georgetown University Hospital.
Stroke Syndrome Treatment and Stroke Prevention
Certain conditions that increase your risk of stroke can be managed with a combination of lifestyle changes and medication. When surgical intervention is required, we offer the most recent advances in minimally-invasive approaches. For safer surgery, our specially trained neurologists use state-of-the-art electrophysiological monitoring equipment to give your neurosurgeon real-time feedback on your brain function during surgery.
The carotid arteries of the neck supply the brain with oxygen-rich blood. Major and minor traumas to the neck and genetic disorders can sometime cause a small tear to form in one of the carotid arteries. When this tear forms, the pressurized, oxygen-rich blood being pumped from the heart to the brain begins to force itself into the wall of the artery at the tear site. Carotid artery dissection is a major cause of stroke. The blood flow gradually spills through the layers of the arteries, causing the artery to swell. This increases the risk of blood clot formation or the bursting of the blood vessel.
Diagnosing Arterial Dissection
When a patient presents with symptoms of arterial dissection, neurologists use state-of-the-art imaging techniques such as computed tomography angiography (CTA), magnetic resonance angiography (MRA), and ultrasound to visualize the blood flow through the carotid artery and abnormalities in the artery’s structure.
Treating Arterial Dissection
Carotid artery dissection is often treated with clot-busting or blood-thinning medications. For patients unresponsive to medication-based treatment, minimally-invasive surgical treatment may be recommended, including angioplasty to repair the tear in the artery or the placement of a stent (a mesh-like tube) within the artery to hold it open and promote healthy blood flow.
Moyamoya disease is a rare condition that causes the arteries supplying oxygen-rich blood to the brain to narrow over time, increasing the risk of stroke. Moyamoya often affects the carotid arteries located in the base of the brain. Other arteries in the brain may become enlarged to compensate for the loss of blood flow through the carotids.
Diagnosing Moyamoya Disease
Although Moyamoya disease often has no known cause, it can sometimes be associated a family history of the disorder, Japanese or Korean heritage, or the presence of sickle cell disease. Most patients are diagnosed following a stroke or transient ischemic attack (TIA) known as a ‘mini-stroke.’ The enlarged arteries compensating for the loss of carotid blood flow may appear like a puff of smoke on a magnetic resonance angiography (MRA) imaging studies that use strong magnets to map the blood vessels of the brain. The disease is named ‘Moyamoya’ after the Japanese word for ‘puff of smoke.’
Treating Moyamoya Disease
We are a regional leader in the surgical treatment of Moyamoya disease. Our Moyamoya specialists use advanced imaging techniques to assess disease severity and evaluate treatment options. Imaging techniques employed may include cerebral angiograms, which use contrast dyes injected into the arteries to provide specialists with real-time blood flow data.
Moyamoya disease is often treated using bypass surgery, also known as cerebral revascularization. This surgery bypasses the narrowed arteries to increase blood flow to the brain and reduce the risk of stroke. Neurosurgeons at MedStar Georgetown University Hospital perform a range of minimally-invasive microsurgical and bypass surgery techniques including STA-MCA bypass surgery connecting the superficial temporal artery (STA) to the middle cerebral artery (MCA) via an artery taken from your scalp. To connect these tiny arteries, that are less than two millimeters in diameter, with sutures thinner than a human hair, our neurosurgeons use state-of-the-art technology and microsurgical techniques.