Stroke Program

Program Overview

Hoag’s comprehensive Stroke Program is led by fulltime neurohospitalists who specialize in advanced stroke management and intervention, and continue to develop best practice care pathways for optimal outcomes. As a founding member of the designated Comprehensive Stroke Neurology Receiving Centers in Orange County, Hoag helped pioneer many of the specialized processes and methods to reverse stroke when possible, and to optimize care for stroke patients. The ultimate outcome metric is the patient’s ability to return to a self-sufficient life, an outcome we measure in every patient with a 90-day survey.

Our stroke rescue process starts immediately on arrival with assessment of the patient by our experts, and triage for the most advanced treatment appropriate to the patient’s condition. As part of the stroke team, Hoag’s Emergency Department physicians and staff initiate the stroke protocol.

In place since January 2008 but continuously updated, the so-called “Code 20” process is like a NASCAR pit crew. Upon a stroke patient’s arrival at the ED, neurological assessment, lab testing, and neuro imaging are done within 20 minutes. Evidence-based use of clot-busting drug treatments, as well as endovascular mechanical intervention – “thrombectomy” – optimizes the chances for stroke reversal. Our team has the longest experience with endovascular stroke rescue in Orange County.

Patients are then cared for in the hospital’s Neurosurgical Intensive Care Unit and/or the 41- bed Advanced Brain and Spine Unit. All stages of care are staffed with nurses experienced in the diagnosis, treatment, and complications of stroke patients. Hemorrhagic strokes, including aneurysmal rupture, have a distinct care pathway, led by our neurosurgeons, neuro-interventional radiologists and neurohospitalists together with our intensive care physicians. Preventative aneurysm treatment using image-guided micro-interventional techniques is a component of the Stroke Program’s portfolio, and is also used in acute aneurysm rupture.

Hoag’s Newport Beach campus is a certified Comprehensive Stroke Center and Hoag Irvine is a certified Primary Stroke Center by DNVGL. Hoag has been awarded the Stroke Gold PLUS Performance Achievement Award by the American Stroke Association for nine years in a row. In 2018, Hoag achieved the Target Stroke Honor Roll Elite Award by the American Heart Association / American Stroke Association.

Hoag has dramatically increased the rate at which IV tPA is administered to all acute ischemic stroke patients – up from 2% a decade ago to 14% currently. This rate triples the national average of 5%. Of the patients arriving in the Emergency Department meeting the criteria for the drug, 100% of patients received treatment. At 90 days, 54% of Hoag’s stroke patients return to a self-sufficient lifestyle.

Hoag’s Stroke Program is led by David Brown, M.D., a neurologist with a specialty in stroke and cerebrovascular disease and a neurohospitalist. Dr. Brown leads the dedicated, multi-disciplinary acute stroke team that provides immediate care to stroke patients, and meets regularly for process improvement.

The Stroke Program Manager is Deb Mastrolia, R.N. Deb is certified with the American Board of Neuroscience Nursing for both Neuroscience nursing (CNRN) and Stroke nursing (SCRN) along with the American Association of Critical Care nursing (CCRN) specialty. She has worked with Dr. Brown to develop and certify the multidisciplinary stroke team. She also consults as a program reviewer for Stroke certifying agencies. Our Physical Rehabilitation service, including the Fudge Acute Rehabilitation Unit is also key to our superior outcomes.

The Stroke Nurse Navigator is Victoria Tomczak, R.N., S.C.R.N. She works collaboratively with the multidisciplinary team to oversee the patients, care and manage quality. She meets with the patients and families to assess individual needs for treatment, prevention and education.

Stroke Picture

To learn more, visit the Stroke Program section or call 949-764-6066.

Functional Outcomes

All stroke survivors are called at 30 days and 90 days post discharge by the stroke nurse navigator. A telephone interview is performed to assess functional status of the survivor. Valuable teaching is reinforced regarding neurology follow-up appointments, medication teaching, risk factor modification, stroke symptom identification and the need to call 911 for any recurring signs of stroke.

Hoag continues to have the second highest volume of ischemic stroke patients in the state of California.

Hoag Stroke Volumes

Hoag Stroke Volumes: Both Campuses,
Principal Discharge Diagnosis

Total Strokes Treated: Primary & Secondary Diagnosis
of Stroke, From the GWTG database

Before-Clot-Removal
Stroke: Before Clot Removal
After-Clot-Removal
Stroke: After Clot Removal

Gold “Get with the Guidelines” Stroke Core Measures

Gold Plus “Get with the Guidelines” Stroke Quality Measures

Get with the Guidelines 2018

Treatment Combined HNB & HHI

Overall treatment rate = 15% • At Comprehensive HNB TX rate = 17.2% • At Primary HHI Tx rate = 7.8%

CY 2018 Thrombolytic Treatments

Increasing Trends of Thrombolytic Treatments for Acute Ischemic Stroke

Number of Acute Ischemic Stroke Thrombectomy Cases

Combined HNB & HHI mRS Results for all Ischemic Strokes

When patients get to Hoag in the time window where acute stroke rescue is indicated, their outcomes are nationally well above benchmarks: over 70% return to a self-sufficient status when treated with IV Alteplase (IpA).

Modified Rankin Score Data for 90 Days for Ischemic Str oke Treated With Thrombolytic Therapy

RAPID Image Sample. Note core infarct (purple) vs. salvageable ischemic penumbra.
CT Perfusion images showing brain tissue at risk of dying due to insufficient blood flow (Blue green area, left picture, and blue area right picture). Middle picture shows that the at risk area can be salvaged by urgent clot removal.

Support & Education

A stroke support group meets monthly in the Hoag Conference Center, as does a brain aneurysm & AVM support group. There is an educational presentation at each, along with Q&A facilitated by the stroke nurse navigator. The meetings are attended by survivors and their families and friends. Community outreach is provided through educational presentations by Dr. Brown and Deb Mastrolia at both Hoag Hospital Newport Beach and Hoag Hospital Irvine. They teach the signs and symptoms of a stroke, stroke prevention and treatments. The Stroke Program also attends employee health fairs, senior centers and events, and performs blood pressure checks, while reviewing stroke risks and prevention. Beth McIntyre serves as the Neuroscience Data Coordinator. Beth’s role has been instrumental in assisting with data compilation for the Stroke Program.

Interventional Neuroradiology Humanitarian Use Devices (HUDs)


Dr. Michael Brant-Zawadzki, Principal Investigator: Boston Scientific Target Neuroform™ Microdelivery Stent System and Neuroform EZ Stent System for Cerebral Aneurysm (H020002)



Dr. Wallace Peck, Principal Investigator: Stryker Corporation Wingspan™ Stent System with Gateway™ PTA Balloon Catheter for Cerebral Anerysm (H050001)



Dr. Wallace Peck, Principal Investigator: MicroVention Low-profile Visualized Intraluminal Support (LVIS®) or LVIS Jr. Humanitarian Use Device (“LVIS HUD”) for Cerebral Aneurysm

Clinical Research

Dr. David Brown, Principal Investigator: Sleep SMART “Sleep for Stroke Management And Recovery Trial: Phase 3 Multicenter, Prospective Randomized Open-, Blinded-Endpoint (PROBE) Controlled Trial To Test Whether Treatment Of Obstructive Sleep Apnea (OSA) With Continuous Positive Airway Pressure Is Effective For Secondary Prevention And Recovery After Stroke.” Funded By NINDS.

Publication

Evolution of a US County System for Acute Comprehensive Stroke Care. Radoslav I. Raychev, Dana Stradling, Nirav Patel, Joey R Gee, David A. Lombardi, Johnson L. Moon, David M. Brown, Mayank Pathak, Wengui Yu, Samuel J. Stratton, and Steven C. Cramer. Originally published 6 Apr 2018. https://doi.org/10.1161/ STROKEAHA.118.020620. Stroke. 2018; 49: 1217-1222.

primary stroke center and comprehensive stroke center