Cleveland Clinic has one of the highest stroke-related patient volumes in North America, with more than 3,200 visits annually. High patient volumes allow our specialists to have vast experience with stroke patients, which results in a team solely dedicated to the comprehensive care and management of strokes.
Stroke Center Certification
At Cleveland Clinic, our Joint Commission Certified Comprehensive Stroke Center at our main campus provides life-saving care for stroke patients in your community. Interventional stroke capabilities are available at Hillcrest and Fairview hospitals. Also, our network of seven Primary Stroke Centers and five Stroke Ready Centers use consistent protocols to ensure the best outcomes for patients.
Primary Stroke Centers:
- Ashtabula County Medical Center
- Euclid Hospital
- Fairview Hospital
- Hillcrest Hospital
- Marymount Hospital
- Medina Hospital
- South Pointe Hospital
Stroke Ready Centers:
- Leading-edge facilities
- Most advanced diagnostic tools: CT, MRI, duplex ultrasound, biplane neuroangiography, carotid ultrasound and Transcranial Doppler
- Comprehensive, advanced treatments including the latest “clot-busting” medication and endovascular (from within the blood vessel) techniques.
- Neurological rehabilitation services, including three inpatient rehabilitation hospitals, as well as outpatient occupational, physical and speech therapy services available throughout Northeast Ohio.
- Critical Care Transport services ensure critically ill and injured patients are quickly and safely transported to Cleveland Clinic via ground mobile intensive care unit, helicopter or airplane.
- Cleveland Clinic has one of the first Mobile Stroke Treatment Units in the country, bringing advanced stroke care to patients to shorten the time between the onset of stroke-like symptoms and the delivery of “clot-busting” – or thrombolytic – drugs.
What We Treat
- Arteriovenous Malformations
- Brain Aneurysm
- Intracranial Hemorrhage, Cerebral Hemorrhage & Hemorrhage Stroke
- Myoyamoya Disease
- Mobile Stroke Unit
- Moyamoya Disease Program
- Surgical & Endovascular Services
Diseases & Conditions
Cerebrovascular illnesses include a number of conditions, each requiring a unique, individualized approach to care. Our center provides treatment for all cerebrovascular conditions, including:
- Arteriovenous Malformation (AVM) of the Brain or Spine
- Carotid Stenosis
- Cerebral Infarction
- Intracerebral Hemorrhage
- Intracranial Atherosclerosis
- Subarachnoid Hemorrhage
- Transient Ischemic Attack (TIA)
Treatments & Services
Emergency Stroke Services
Our Emergency Department and the Primary Stroke Center Team are in constant communication throughout the care of the stroke patient, from the time the patient is brought through the doors, to the CAT scan machine, up until the patient is admitted into one of the 106 specialized neurological care beds. The stroke team has a dedicated pager that is used throughout the institution when someone is exhibiting stroke like symptoms. The team is paged and they will know when and where the patient is coming from, so they will be present upon patient arrival to evaluate the patient. They will accompany the patient to the CAT scanner and remain with the patient during the diagnostic decision making process.
Cleveland Clinic's Emergency Department staff is certified in the use of NIHSS, or the National Institute of Health Stroke Scale. The NIHSS was developed by the National Institute of Health and is used to determine the severity of a stroke. It is a standard unit of measure that is used to evaluate all stroke patients. By using the NIHSS the nursing staff and the physicians can communicate accurately regarding the patient’s neurological condition.
Rehabilitation Institute Comprehensive neurological rehabilitation services offer outpatient physical, occupational and speech therapy programs for patients with neurological conditions. Our therapists specialize in neurological treatment, are involved in research and stay abreast of current treatment approaches using evidence-based practice. Our therapists evaluate the specific needs of the patient and select a technique or a combination of techniques to serve the individual’s needs. Techniques can include, but are not limited to the following:
- Repetitive task practice
- Motor relearning
- Modified constraint-induced therapy
- Neuro-developmental treatment (NDT)
- Electrical stimulation and/or fluidotherapy
- Learn more about Stroke & Neurological Rehabilitation
Diagnostics & Testing
Our state-of-the-art facility is equipped with the diagnostic tools needed to quickly assess cerebrovascular conditions, including:
- Computed Tomography (CT)
- Magnetic Resonance Imaging (MRI)
- Duplex Ultrasound
- Digital Subtraction Angiography
- Carotid Ultrasound
- Transcranial Doppler (TCD), which provides real-time information that cannot be obtained through static images like CT and MRI.
Cleveland Clinic’s Neurovascular Ultrasound Laboratory in the Imaging Institute performs advanced, unique diagnostic examinations to detect abnormalities in the circulation of blood through the brain. Our lab, which performed more than 3,000 exams in 2008, has a national and international reputation for excellence in developing and applying the newest technology in neurovascular ultrasound for clinical research purposes. All our examinations are reviewed by board-certified neurologists or neuroradiologists and are performed by registered neurovascular sonographers.
Most imaging modalities can tell physicians if the blood vessels in the neck and brain are open. However, the exams performed in our Neurovascular Ultrasound Laboratory can also tell physicians how fast the blood is moving within these vessels. The velocity of the blood flow is important in assessing why a patient suffered a stroke or TIA and in determining the success of interventions after stenting and angioplasty.
What examinations are offered in the Neurovascular Ultrasound Laboratory?
The Neurovascular Ultrasound Laboratory offers a variety of non-invasive, cost effective tests for the assessment of cerebrovascular disease through the use of state-of-the-art equipment and technology. For the majority of these tests, no patient preparation is required, and testing usually takes less than one hour. Appointments are required.
Carotid Duplex Ultrasound
Carotid duplex ultrasound uses imaging technology to look for blood clots, plaque build-up and other blood flow problems in the carotid arteries. Our physicians use this technology to expertly diagnosis vessel stenosis (or narrowing of the vessels), occlusion, dissection, fibromuscular dysplasia, aneurysm, carotid body tumors and subclavian steal syndrome. Indications for use of carotid duplex ultrasound include transient ischemic attacks (TIA), stroke and Vertebrobasilar insufficiency.
Transcranial Doppler Examination
Transcranial Doppler (TCD) is used to evaluate the blood flow through the blood vessels in the brain. An ultrasound transducer is placed over the temporal bones on the side of the skull, the foramen magnum in the back of the skull and over the closed eye lid. A reading of the blood flow is obtained from the vessels at the base of the brain (Circle of Willis).
The TCD exam is primarily used for the detection of intracranial stenosis (the narrowing of the vessels), thrombosis, occlusion or dissection. It is also used for the detection of vasospasm, the narrowing of the blood vessels in the brain that occurs following a subarachnoid hemorrhage. Indications for the TCD examination include transient ischemic attacks (TIA), stroke and vertebrobasilar insufficiency.
Transcranial Doppler Emboli Monitoring
Emboli are small pieces of plaque or “clots” that can form in the heart or break off plaque within blood vessels. Emboli passing through the blood stream can block a vessel in the brain and can be the cause of a TIA or stroke.
Transcranial Doppler Emboli Monitoring can detect any object that is not a red blood cell that passes our ultrasound beam. A vessel will be monitored for 30 minutes. The detection of emboli can provide a better understanding of what is causing a stroke, help direct therapeutic management and identify the patients who are at an increased risk of having a stroke.
Additional testing offered in the Neurovascular Ultrasound Laboratory includes:
- Transcranial Doppler Imaging (TCI)
- Transcranial Doppler Bubble Testing (TCB) for the detection of a hole between the chambers of the heart and patent foramen ovale
- Transcranial Doppler of the posterior circulation (TCP), which evaluates the bilateral subclavian arteries, extracranial and intracranial vertebral arteries and basilar artery within the posterior aspect of the brain. Indications include syncope (passing out), dizziness and blurred vision.
- Intraoperative monitoring of intracranial blood flow
- Transcranial Doppler in sickle cell disease
Cleveland Clinic’s Neurovascular Laboratory welcomes referrals from outside physicians. For an appointment, call the radiology call center at 216.738.5460 or toll-free at 866.320.4573.
For more information, please contact Larry Raber, RDMS, RVT, RT(R), clinical manager of the Neurovascular Ultrasound Laboratory at 216.444.9129.
Make an Appointment
To schedule an appointment with a specialist in the Cerebrovascular Center, please call us locally at 216.636.5860 or toll-free 866.588.2264.
Refer a Patient
To help patients receive the care they need as quickly as possible, the Cerebrovascular Center developed a referring physician line specifically designed to ease the process of transferring patients with critical cerebrovascular conditions.
With one phone call to a transfer specialist, all necessary arrangements can be made to receive your patient. If necessary, your patient can be transported to our facility using our ambulance or helicopter service, which is available 24 hours a day, 7 days a week.
To arrange for a consult or referral to the Cerebrovascular Center, call our referring physician line at 800.553.5056.
For urgent stroke transfers, call 800.553.5056 and request the 2-CLOT pager (22568) for direct contact with a Cerebrovascular Center staff member.
Pipeline® Embolization: an advanced procedure to stent large proximal carotid artery aneurysms
A device that received FDA premarket approval in April 2011, the Pipeline® Embolization Device allows for true reconstruction of large or giant wide-necked intracranial aneurysms (IAs). The Cleveland Clinic Neurological Institute's Cerebrovascular Center is one of just a few centers in the United States approved to utilize this device.
The Pipeline Embolization Device is a fine-mesh stent that diverts blood flow away from the aneurysm in order to provide a complete and durable embolization while maintaining patency of the parent vessel. The stent is a bimetallic design of 75 percent cobalt chromium and 25 percent platinum tungsten; it comprises 48 densely braided strands. It is “customizable” in that multiple devices can be telescoped together, one inside the next, for longer constructs.
Proximal carotid artery aneurysms larger than 1 centimeter in diameter, which are often dysplastic are notorious for returning after surgery or endovascular procedures. The leading-edge Pipeline stent, which has seen positive success in Europe and South America for more than a year, allows for aneurysm repair that previously would have been dangerous to repair or inoperable.
Essentially, it provides a potential cure for patients who otherwise have very poor long-term prognoses.
Approximately 300,000 brain aneurysms rupture each year, and less than 1 percent of the 300,000 are large proximal carotid artery aneurysms.
Interestingly, patients with these aneurysms are a bit older – age 50 to 70 – than the general population of aneurysm patients, whose age averages 40 to 60. We don't know why that is; it's possible that these aneurysms have simply had an extra decade or so to grow.
Previously, even for experienced neurosurgeons, the risks and outcomes with these large and giant aneurysms have been difficult to predict. There were three choices:
- palliative treatment only.
- traditional brain surgery, in which a hairpin clip is inserted under the cranium, pinching the bubble of the aneurysm shut and allowing the brain and vessels to return to their natural shape.
- an endovascular procedure, in which a catheter is inserted at the thigh and, under X-ray, navigated to the head to allow the insertion of a stent. In some cases, these stents successfully circumvented the aneurysm, but were not successful in preserving the blood vessel. In addition, for aneurysms with no defined bubble – dysplastic aneurysms – placement of the stent was challenging.
The Pipeline Embolization Device gives us another option: one specifically designed for this type of large aneurysm, which, even if surgery or an endovascular procedure is successful, often have recurred.
Previous generations of stents have allowed us to remodel the vessel around the aneurysm. Stents in general led to good outcomes in many cases by generating not only mechanical benefits, propping up the vessel wall, but biological benefits as well. As the vessel remodels itself and overgrows the stent, the vessel lining can actually grow over the stent, further strengthening the vessel.
But older stents, because of their mesh construction, have not been completely successful at redirecting blood flow; blood can, in fact, simply flow through the mesh.
The new device provides a mesh so tightly woven that it does redirect blood flow past the aneurysm so that the aneurysm can clot off and heal over itself.
The international success rate with this flow-diverting stent has been stellar: Some 90 to 95 percent of the aneurysms so treated never came back, according to the available literature. To put that in perspective, the risk of complications after simple aneurysm surgery is 3 to 4 percent; the complication rate in other stent procedures has been about 5 percent.
For Medical Professionals
Our state-of-the-art facility is equipped with the diagnostic tools needed to quickly assess stroke, including computed tomography (CT), magnetic resonance imaging (MRI), duplex ultrasound, digital subtraction angiography, carotid ultrasound and Transcranial Doppler (TCD), which provides real-time information that cannot be obtained through static images like CT and MRI.
The Cerebrovascular Center now offers telestroke services. The service provides 24x7 coverage by a specialty trained physician to assist medical centers in the assessment and treatment of their stroke patients. To facilitate an ongoing, real-time consultation, the Telestroke Network is enabled with a 2-way, portable videoconferencing system as well as a dedicated link between imaging systems. The physician assessment is also supported by Cleveland Clinic's Critical Care Transport services, should the patient need additional care.
The Cerebrovascular Center’s comprehensive treatment approach offers an array of medical and interventional treatment options for acute stroke including t-PA administration, intra-arterial thrombolysis and mechanical revascularization.
Neurointensive Care Unit
Cleveland Clinic’s Neurointensive Care Program is a multidisciplinary program dedicated to treating patients with the most severe, acute neurological diseases.
Our physicians use state-of-the-art technology and compassionate holistic treatment to give patients the best chance for recovery. Our qualified team of critical care professionals provides treatment for patients with the following neurological conditions:
- Major acute stroke
- Subarachnoid hemorrhage
- Intracerebral hemorrhage
- Spine injury
- Status Epilepticus
- Post-operative neurosurgery patients
- Myasthenic crisis
- Guillain-Barre Syndrome
- Brain tumor patients who require intensive care
Neurointensive Care Unit
Within our 22-bed, state-of-the-art dedicated Neurointensive Care Unit (NICU), we treat more than 1,300 patients per year, with 24/7 coverage. This full service NICU is equipped to treat any patient with neurological injury, regardless of the severity. The NICU also is equipped to handle any heart, lung and gastrointestinal problems that may arise in neurological patients. In addition, we have specialized equipment specifically for the treatment of patients with neurological illnesses, including inside-the-brain oxygen sensors and blood flow monitors, and portable head Computed Tomography (CT) scanning.
Neurointensive Care Team
Our healthcare professionals work as a team to provide patients with the best care. This team includes neurologists, neurosurgeons, specially trained nurses, respiratory therapists and pharmacists, under the direction of specially trained neurointensivists. In addition, nutritionists, speech pathologists, social workers, clergy, ethicists, physical and occupational therapists and case managers collaborate on the care of patients.
Our staff devotes a significant amount of time to research activities that focus on improving the care of patients with brain injuries. We have a dedicated laboratory that studies the cause of strokes that occur after the rupture of an aneurysm in the brain (subarachnoid hemorrhage). In addition, we also study the cause of heart damage after a subarachnoid hemorrhage. Our clinical research includes determining the best time to transition NICU patients from a breathing machine to breathing on their own. We also test new medicines and devices to improve the care of our patients. Some of our current projects include:
- The role of inflammation in vasospasm after aneurismal subarachnoid hemorrhage
- The mechanism and outcome of cardiac damage after subarachnoid hemorrhage
- Predictors of extubation success in neurologically injured, ventilated patients
- The role of a new calcium channel blocker in hypertension after intracerebral hemorrhage (ACCELERATE)
Our staff is invited all over the world to give presentations and lectures. Our national activities include publications in peer-reviewed journals, papers and posters presented at national meetings and a strong annual presence at the Neurocritical Care Society, Society of Critical Care, American Society of Anesthesiology and American Heart Association Stroke meetings. In addition, members of our staff are fellows of the American College of Critical Care Medicine and board members of the Neurocritical Care Society.
- Provencio JJ. Subarachnoid hemorrhage: a model for heart-brain interactions. Cleveland Clinic Journal of Medicine. 74 Suppl 1: S86-90, 2007.
- Provencio, JJ, Vora, Nirav. Subarachnoid Hemorrhage and inflammation: Bench to bedside and back. Seminars in Neurology. 2005, 25(4): 435-444.
- Boissy, AR, Provencio, JJ, Smith CA, Diringer, MN. Neurointensivists opinion about the diagnosis of death by neurological criteria, organ donation and donation after cardiac death. Neurocritical care. 2005, 3(2): 115-121.
- Deogaonkar, A, Gupta, R, DeGeorgia, M, Sabharwal, V, Gopakumaran, B, Schubert, A, Provencio, JJ. Bispectral index monitoring correlates with sedation scales in brain injured patients. Crit Care Med. 32: 2403-2406. 2004.
- Suarez JI. Zaidat OO. Suri MF. Feen ES. Lynch G. Hickman J. Georgiadis A. Selman WR. Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Critical Care Medicine. 32(11): 2311-7, 2004.
- Suarez JI. Shannon L. Zaidat OO. Suri MF. Singh G. Lynch G. Selman WR. Effect of human albumin administration on clinical outcome and hospital cost in patients with subarachnoid hemorrhage. Journal of Neurosurgery. 100(4): 585-90, 2004.
Stroke is the leading cause of serious, long-term disability in the United States, with about 6.5 million stroke survivors alive today. Listen to free audio files from Cleveland Clinic’s Cerebrovascular Center about stroke risk factors, warning signs and treatment options.
- Risk Factors and Treatment Options for Stroke
- Brain Aneurysm: More Than Just a Headache
- Treatment and Care for Pediatric Stroke
- Treatment Options in Acute Ischemic Stroke
In the News
Stroke Ambulances Dramatically Cut Treatment Time. CBS This Morning, March 9, 2017.
Stroke and Brain Aneurysm Support Group
Each year nearly 800,000 Americans experience a new or recurrent stroke, which is the nation’s third leading cause of death. Up to 6 percent of the population of the United States may be living with an unruptured aneurysm, while an estimated 30,000 people will experience a ruptured cerebral aneurysm in the next year.
We are pleased to introduce a new support group for people who have suffered a stroke or brain aneurysm, whether last month or last year. Our goal is to provide support and information to survivors.
How can a support group serve you?
- Learn about preventing future strokes and aneurysms
- Connect with others who understand the challenges first hand
- Generate and share ideas for better self-care
- Inspire one another to be strong and improve overall quality of life
- Utilize your own experiences to help others
Support Group Meetings:
- Monday, July 31, 2017 | 10 a.m. – 11:30 a.m.
- Monday, September 18, 2017 | 10 a.m. – 11:30 a.m.
- Monday, November 6, 2017 | 10 a.m. – 11:30 a.m.
Location: Cleveland Clinic Independence Family Health Center
Lower Level Conference Room A
5001 Rockside Road
Crown Center II
Independence, OH 44131
No registration required
For more information: 216.636.0450
Preventive Measures and Strategies
Preventing future cerebrovascular conditions is also an important service offered by the Cerebrovascular Center. Our preventive measures and strategies include:
- Identifying and managing lipid disorders in order to reduce the likelihood of symptomatic atherosclerosis in the brain.
- Encouraging participation in smoking-cessation programs for patients who smoke (smoking is one of the major risk factors).
- Educating patients through cardiovascular risk-reduction clinics about what lifestyle habits put them most at risk for both strokes and heart attacks.
Healthy diet, exercise, controlling blood pressure and not smoking are cornerstones of stroke prevention.
- Control your blood pressure.
- Find out if you have heart disease, especially an irregular heartbeat known as atrial fibrillation.
- Don’t smoke.
- Find out if you have a diseased carotid artery.
- Lower your cholesterol.
- Limit your alcohol intake.
- Control your weight.
- If you have diabetes, manage the disease.
- View our Stroke Treatment Guide
Wellness & Nutrition
Simple everyday tips to help you reduce your risk factors for stroke.