Overview

Overview

Our center of excellence for cerebrovascular care offers:

  • Leading-edge facilities with the ability to care for the most acute and complex patients featuring state-of-the-art cerebrovascular operating suites, neurointerventional angiography and hybrid open-interventional operating suites and the most advanced imaging tools including CT, MRI, duplex ultrasound, biplane neuroangiography, carotid ultrasound and Transcranial Doppler ultrasound.
  • A personalized approach to brain aneurysm treatment featuring the latest device technology including flow diversion techniques and new types of coils, stents and support devices for the treatment of complex wide neck aneurysms.
  • One of the nation’s largest, and the largest in Northeast Ohio, stroke practices; offering comprehensive, advanced stroke treatments including the latest "clot-busting" medication and endovascular (from within the blood vessel) techniques.
  • One of the first Mobile Stroke Treatment Units in the country and the only in Northeast Ohio, bringing advanced hemorrhagic and ischemic stroke care to patients to shorten the time between the onset of stroke-like symptoms and the delivery of "clot-busting" (or thrombolytic) drugs.
  • Critical Care Transport services to ensure critically ill and injured patients are quickly and safely transported to Cleveland Clinic via mobile ground intensive care unit (ambulance), helicopter or airplane.
  • A multidisciplinary neuro intensive care team that treats the most acute patients utilizing  advanced technology for multi-modal monitoring, providing 24/7 coverage and immediate access.
  • Neurological rehabilitation services, including three inpatient rehabilitation hospitals, as well as outpatient occupational, physical and speech therapy services available throughout Northeast Ohio.
What We Treat

What We Treat

Cerebrovascular illnesses include a number of conditions, each requiring a unique, individualized approach to care.

Diseases & Conditions

Diagnostics & Testing

Our state-of-the-art Neurovascular Ultrasound Laboratory is equipped with the diagnostic tools needed to quickly assess cerebrovascular conditions, including:

All examinations are reviewed by board-certified neurologists or neuroradiologists and are performed by registered neurovascular sonographers.

Cleveland Clinic’s Neurovascular Ultrasound Laboratory welcomes referrals from outside physicians. To make an appointment or referral, please call 216.738.5460 or 866.320.4573.

For more information on the Neurovascular Ultrasound Laboratory, please contact Larry Raber, RDMS, RVT, RT(R), clinical manager of the Neurovascular Ultrasound Laboratory at 216.444.9129.

Treatments & Services

Stroke Program

Stroke Program

Cleveland Clinic has one of the highest stroke-related patient practices 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.

Patients who have experienced a stroke are managed by a team of specialists who provide care from onset of the stroke to rehabilitation and management post-stroke. The team of specialists includes:

  • Stroke/Vascular neurologists
  • Interventional neurologists and neuroradiologists
  • Vascular neurosurgeons
  • Neurocritical care specialists
  • Psychologists
  • Physiatrists
  • Advanced practice providers
  • Therapists including physical, occupational, speech-language and recreational therapists
  • Pathologists
  • Social workers and case managers
  • Nurse care coordinators

The team in Cleveland Clinic’s Stroke Program is focused on resolving the cause of the stroke, managing after effects, reducing disability and maintaining/restoring quality of life. For patients and caregivers of patients who have suffered a stroke, members of Cleveland Clinic’s Stroke Program will provide education on:

Stroke Center Certification

Comprehensive Stroke Center

The stroke center on Cleveland Clinic's main campus, which also provides care to stroke patients presenting at Cleveland Clinic’s freestanding emergency departments in the Brunswick Family Health Center, Lakewood and Twinsburg Family Health and Surgery Center, is a Joint Commission certified Comprehensive Stroke Center. This is the highest level of stroke certification, only earned by an elite group of hospitals across the United States for providing state-of-the-art, leading-edge care for the most complex stroke cases.

Comprehensive Stroke Center Certification means that 24 hours a day, 7 days a week we work with EMS and other stroke centers to deliver advanced stroke care. At Cleveland Clinic's main campus the Acute Stroke Emergency Response Team meets patients at the door, whether they arrive via EMS, Mobile Stroke Treatment Unit or Critical Care Transport helicopter.

Rapid diagnosis by advanced imaging protocols and highly trained neuroradiologists ensures quick intervention, including Alteplase (tPA) and endovascular interventions. Our state-of-the-art interventional suites allow our staff to perform advanced diagnostic and endovascular interventional procedures on patients suffering from acute stroke and other cerebrovascular emergencies, including aneurysm coiling, aneurysm clipping, cerebral vessel stenting, clot removal (mechanical thrombectomy) and Pipeline® embolization.

Primary Stroke Centers & Stroke Treatment-Capable Hospitals

The Comprehensive Stroke Center on Cleveland Clinic's main campus serves as the hub in an integrated stroke care network. Cleveland Clinic's health system boasts an additional eight Joint Commission certified Primary Stroke Centers and two regional hospitals capable of initiating acute stroke treatment, including:

Primary Stroke centers

Stroke Treatment-Capable Hospitals

Stroke Gold Plus Award

In 2018, Cleveland Clinic's main campus Comprehensive Stroke Center received the American Heart Association/American Stroke Association's Get with the Guidelines® Stroke Gold Plus Stroke award. In addition, Cleveland Clinic received Target: Stroke Elite Plus recognition. Cleveland Clinic's health system boasts an additional nine hospitals identified for exceptional care through the Get with the Guidelines® award. These achievements recognize Cleveland Clinic's commitment and success in implementing the highest standard of stroke care by ensuring that stroke patients receive treatment according to nationally accepted standards and recommendations. Additional awarded facilities include:

Stroke Gold Plus, Target Honor Roll Elite Plus

Stroke Gold Plus, Target Honor Roll Elite

Stroke Gold Plus, Target Stroke Honor Roll

Stroke Gold Plus

Stroke Silver Plus, Target Stroke Honor Roll Elite

BE FAST

Cleveland Clinic's commitment to stroke care includes education to all on the warning signs of a stroke. In a stroke, every minute counts. Use the BE FAST method to evaluate whether someone may be having a stroke:

  • Balance: Watch for a sudden loss of balance.
  • Eyes: Is there a sudden loss of vision in one or both eyes? Or double vision?
  • Face: Ask the person to smile. Does one side of the face droop?
  • Arms: Ask the person to raise both arms. Does one arm drift downward?
  • Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
  • Time: If you observe any of these signs, call 9-1-1 immediately.
Cerebrovascular Surgery

Cerebrovascular Surgery

Cleveland Clinic performs more than 1,700 cerebrovascular procedures each year. Our team of specialists treat everything from carotid stenosis to complex brain aneurysms. Teamwork and putting patients first are the guiding principles for our multidisciplinary team of:

  • Vascular neurosurgeons
  • Interventional neurologists and neuroradiologists
  • Stroke/Vascular neurologists
  • Neurocritical care specialists
  • Psychologists
  • Physiatrists
  • Pathologists
  • Advanced practice providers
  • Therapists including physical, occupational and speech-language therapists
  • Social workers and case managers
  • Nurse care coordinators

Our team offers extensive expertise and application of novel technologies, like biplane neuroangiography, in surgical and endovascular services like:

  • Aneurysm coiling, clipping and flow diversion
  • Arteriovenous malformation treatment
  • Carotid and vertebral artery stenting and endarterectomy
  • Cerebral revascularization surgery (including extra/intracranial brain bypass)
  • Epistaxis treatment
  • Gamma  Knife radiosurgery
  • Intracranial stenting
  • Minimally invasive clot evacuation for hemorrhages
  • Tumor embolization

State-of-the-art cerebrovascular operating suites, neurointerventional angiography and hybrid open interventional suites allow our team to customize aneurysm repair using open microsurgery, endovascular surgery or hybrid open-endovascular surgery.

Research

Besides world renowned clinical care, the cerebrovascular and endovascular neurosurgery program at Cleveland Clinic is a world leader in research and innovation.  Our program is involved in numerous interventional trials pioneering devices and new techniques from flow diverting stents to minimally invasive intracerebral hemorrhage evacuation. 

Neuro ICU

Neuro ICU

The 24-bed Neuro Intensive Care Unit (NICU) on Cleveland Clinic’s main campus provides 24/7 critical care for more than 1,300 acute neurology and neurosurgery patients annually. Our multidisciplinary team is comprised of neurocritical care physicians, advanced practice providers, nurse care coordinators, clinical pharmacy specialists; and respiratory, occupational, and physical therapists, as well as providers from many different specialties and subspecialties. Our innovative model of night coverage relies on advanced practice providers with acute care training complemented with remote tele-ICU presence by staff physicians.  This novel use of telemedicine enables our team to provide second opinion consultations to patients at other hospitals within Cleveland Clinic’s health system.

Our team provides the whole range of direct bedside care for critically ill patients, rather than just consultative services, and routinely cares for patients with the following neurological conditions:

This full service Neuro ICU is equipped to treat any patient with neurological injury, regardless of the severity, and capable of treating any heart, lung or systemic problems that may arise.. We also have specialized equipment designed for the treatment of patients with neurological illnesses, including:

  • Brain oxygen sensors
  • External ventricular drains
  • Intracranial pressure monitoring
  • Invasive blood flow monitors
  • Portable head Computed Tomography (CT) scanning
  • Pupillometers
  • Routine continuous EEG monitoring

We are also in the process of expanding our multimodal monitoring capabilities to include cerebral microdialysis. 

Research

Cleveland Clinic’s Neuro ICU team has been at the forefront of early mobility in patients with brain injuries as a means to decrease medical complications and enhance recovery.  A funded pilot study of early mobilization therapy and aggressive physical therapy in patients following subarachnoid hemorrhage is being completed and has shown promising preliminary results.  Similarly, as part of our comprehensive approach to care, family engagement and patient and family experience are taken very seriously and another funded study is exploring optimal ways to enhance communication between the medical team and families and improve their overall experience during what can be very difficult times.

Our faculty devotes a significant amount of time to research activities that focus on improving the care of patients with brain injuries.  We actively participate in (and often times lead) national studies looking at minimally invasive surgical evacuation of brain bleeds as a possible novel treatment strategy, as well as intravenous infusion of experimental medications to ameliorate brain swelling following ischemic stroke. We also have investigator-initiated translational studies that have secured external funding from national organizations that seek to explore the effect of iron-mediated oxidative damage following aneurysmal bleeding.

Other research projects include the analysis of different reversal strategies for warfarin-related coagulopathy in patients with brain bleeds, the use of direct intrathecal administration of medications to minimize vasospasm after aneurysm rupture, and a variety of smaller projects initiated by trainees.

Our staff is regularly invited to give presentations and lectures at major annual meetings. 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, and international stroke meetings.  Members of our staff regularly review manuscript submissions and abstracts for the most relevant journals and meetings associated with neurointensive care.

Staff Appointments

Appointments

Make an Appointment

To schedule an appointment with a specialist in the Cerebrovascular Center, please call at 216.636.5860 or toll-free 866.588.2264.

Virtual Visits

Select, established patients now can see our providers online from their home or office for follow-up visits by using the Cleveland Clinic Express Care® Online tool. This service allows patients a fast, secure and easy way to receive care from their healthcare team in a live virtual visit using a smartphone (iPhone or Android), tablet or computer. The benefits of choosing a virtual visit include no travel or parking, less waiting, significant time savings, no facility fee and the convenience of seeing your physician from wherever you choose.
If you would like to use Express Care Online for your next visit, please call your provider’s office. If you are eligible, our team will schedule your virtual visit and provide details on the cost of your appointment and setup instructions.

Research

Research

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

For Medical Professionals

Referrals

The Cerebrovascular Center offers a direct referral line 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 Critical Care Transport ambulance or helicopter service, available 24 hours a day, 7 days a week.

To arrange for a consult or referral to the Cerebrovascular Center, please call 800.553.5056.

For urgent stroke transfers, please call 800.553.5056 and the press 1. This will provide direct contact with a Cerebrovascular Center staff member.

For brain aneurysm or cerebrovascular case referrals, please call 216.444.4552. This will provide direct contact with a Cerebrovascular Center staff member.

Stay connected to patients you refer to Cleveland Clinic through online updates and electronic medical records through DrConnect.

Mobile Stroke Treatment Unit

Cleveland Clinic’s mobile stroke treatment unit (MSTU) — one of the first units of its kind in the U.S. — was launched to shorten the time between the onset of a patient’s stroke-like symptoms and the delivery of clot-busting drugs to treat a stroke.

The unit is operated by highly specialized staff who use its advanced equipment to allow Cleveland Clinic stroke physicians to swiftly diagnose stroke and, when appropriate, direct the administration of lifesaving medications while the patient is still en route to an emergency department. Every minute saved before treatment starts is likely to preserve critical brain tissue.

The MSTU, which is integrated into the municipal 911 dispatch system, boasts a critical care team with extensive experience working in and with local rescue squads.

The team includes:

  • A critical care nurse
  • A CT technologist
  • A paramedic
  • An emergency medical technician who assists with stroke care and drives the unit

The team uses the unit’s specialized equipment, including:

  • A portable CT scanner to wirelessly transmit brain images in real time to Cleveland Clinic neuroradiologists reviewing the case
  • A two-way videoconferencing consult system connected 24/7 with Cleveland Clinic stroke neurologists
  • Point-of-care lab equipment that allows the team to test blood samples
  • The clot-busting drug tPA, which the team administers intravenously if the stroke physicians determine that the patient is having an ischemic stroke

To learn more about Northeast Ohio’s only mobile stroke treatment unit or how we can better collaborate with your city, please contact Andrew Russman, DO, Head of Cleveland Clinic’s Stroke Program, at 216.445.1148.

Telestroke Services

The Cerebrovascular Center now offers Telestroke services. The service provides 24x7 coverage by a team including vascular neurologists and neurocritical care specialists, assisting 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.

How Our Telestroke Service Works

  • Call Cleveland Clinic to discuss the patient’s condition.
  • Within minutes, the portable 2-way audio/visual system in your ER brings one of our specialty trained physicians into seamless communication with you and your patient.
  • Patient CT images taken at your medical center are transferred to our physician to assist in the consultation process.
  • Our physician will collaboratively discuss treatment recommendations and options with the ER physician, including the administration of IV tPA. If necessary, patient transfer to Cleveland Clinic for further care can also be coordinated.

To learn more about our Telestroke service and how we can collaborate with your team, please call Dana Collins at 216.445.1383.

Residency & Fellowship

The Cerebrovascular Center has a long-standing tradition of training future leaders in the field of cerebrovascular and endovascular neurosurgery and neurocritical care medicine.  Learn more about residency and fellowship opportunities available through Cleveland Clinic’s Cerebrovascular Center:

CME Programs

The Center for Continuing Education is responsible for one of the largest and most diverse CME programs anywhere in the world. We offer live CME courses and free online CME activities.

Resources

Resources

Stroke Prevention & Detection

Stroke is the leading cause of serious, long-term disability in the United States, with about 6.5 million stroke survivors alive today. 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.

Cleveland Clinic's commitment to stroke care includes education to all on the warning signs of a stroke. In a stroke, every minute counts. Use the BE FAST method to evaluate whether someone may be having a stroke:

  • Balance: Watch for a sudden loss of balance.
  • Eyes: Is there a sudden loss of vision in one or both eyes? Or double vision?
  • Face: Ask the person to smile. Does one side of the face droop?
  • Arms: Ask the person to raise both arms. Does one arm drift downward?
  • Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
  • Time: If you observe any of these signs, call 9-1-1 immediately.

Stroke and Brain Aneurysm Support Group

Stroke and brain aneurysms are serious neurological diseases which can leave a person with a wide variety of deficits affecting them physically, cognitively and/or psychologically.  The Cerebrovascular Center at Cleveland Clinic is dedicated to helping those affected by strokes and brain aneurysms by offering a support group that focuses on alleviating the effects of the disease through support and education. 
Topics discussed vary by meeting, but may include:

  • Rehabilitation challenges
  • Recurrent stroke prevention
  • Updates in stroke treatment
  • Additional support resources 

Participating in a support group allows you to meet others with similar health concerns and issues. It allows you to connect with others in comparable situations and share experiences and coping strategies. Anyone who has suffered a stroke and/or brain aneurysm is welcome to come with or without a family member or support person. 

2018 & 2019 Dates:

  • Monday, November 5, 2018
  • Monday, January 28, 2019
  • Monday, March 11, 2019
  • Monday, May 13, 2019
  • Monday, July 15, 2019
  • Monday, September 23, 2019
  • Monday, November 11, 2019

Time: 10 am - 11:30 am

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

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