Overview
Cerebrovascular disease encompasses a group of conditions that limit or cut off blood flow to affected areas of the brain. It is often caused by atherosclerosis which can sometimes lead to a stroke. On average, a stroke occurs every 40 seconds with nearly 795,000 Americans suffering a new or recurrent stroke every year. Stroke is considered the 4th leading cause of death and the primary source of serious, long-term disability in the United States.
The Department of Neurology physicians at Cleveland Clinic Florida are experts in diagnosing and treating patients suffering from cerebrovascular disorders. Our multi-disciplinary medical team, which includes vascular neurologists, cerebrovascular neurosurgeons, neuroradiologists and rehabilitation specialists, collaborate to develop a comprehensive treatment plan best suited to each patient’s individual needs.
We have a state-of-the-art facility equipped with diagnostic tools such as computed tomography (CT), magnetic resonance imaging (MRI), duplex ultrasound, digital subtraction angiography, carotid ultrasound and Transcranial Doppler (TCD) to detect signs of cerebrovascular disease. Neurological rehabilitation services including outpatient occupational, physical and speech therapy are also available for patients' experiencing disability caused by a stroke or other neurological disorder.
Cleveland Clinic Weston Hospital has been designated a Thrombectomy-Capable Stroke Center by The Joint Commission. Obtaining this certification signifies that Weston Hospital has undergone an extensive onsite evaluation and meets strict national stroke care standards as required by The Joint Commission.
In 2022 Weston Hospital also received the American Heart Association/American Stroke Association's Get With The Guidelines® Stroke GOLD PLUS with Target: Stroke Honor Roll Elite Plus, Advanced Therapy and Target: Diabetes Honor Roll. This achievement recognizes Weston Hospital’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.
Cleveland Clinic Martin Health Tradition Hospital has been awarded certification as a Comprehensive Stroke Center by DNV GL Healthcare. Certification as a Comprehensive Stoke Center is recognition that we are able to offer the highest level of treatment and care available for stroke patients, including advanced neuro-interventional radiology, neurosurgery, and neuro-critical care services. In 2022, Tradition Hospital also received the American Heart Association/American Stroke Association's Get With The Guidelines® Stroke GOLD PLUS with Target: Stroke Honor Roll Elite Plus and Target: Diabetes Honor Roll.
Cleveland Clinic Martin Health North and South Hospital has been designated a Primary Stroke Center by The Joint Commission and in 2022 also received the American Heart Association/American Stroke Association's Get With The Guidelines® Stroke GOLD PLUS with Target: Stroke Honor Roll Elite Plus and Target: Diabetes Honor Roll.
Cleveland Clinic Indian River Hospital has been designated a Thrombectomy-Capable Stroke Center by The Joint Commission and in 2022 also received the American Heart Association/American Stroke Association's Get With The Guidelines® Stroke GOLD PLUS with Target: Stroke Honor Roll Elite Plus and Target: Diabetes Honor Roll.
What We Treat
There are two types of strokes: hemorrhagic and ischemic. An ischemic stroke occurs when blood supply to part of the brain is cut off and a hemorrhagic stroke occurs when brain arteries rupture. In addition to stroke, the spectrum of cerebrovascular disorders also includes brain aneurysms, arterial venous malformations and spinal vascular malformations, carotid stenosis and intracranial atherosclerosis. Cerebrovascular disease includes a number of conditions, each requiring a unique, individualized approach to care. Our physicians treat acute stroke patients in the hospital and provide outpatient consultations for the following cerebrovascular conditions:
- Aneurysmal subarachnoid hemorrhage.
- Atherosclerosis-producing carotid stenosis or intracranial stenosis.
- Brain aneurysms.
- Brain and spinal vascular malformations.
- Cardioembolic stroke.
- Cerebral hemorrhage.
- Dural arteriovenous shunts.
- Head and neck vascular malformations.
- Ischemic stroke and transient ischemic attacks.
- Other arteriopathies such as dissection and fibromuscular dysplasia.
- Pipeline Stent for brain aneurysms.
- Rare causes of stroke, such as cerebral vasculitis, Moyamoya disease, mitochondrial disorders and CADASIL.
Diagnostics
Services we offer
Diagnostic examinations are conducted using state-of-the-art imaging equipment and technology such as:
Computed Tomography [64-slice Computed Tomography (CT), CT Angiography] – scan performed to detect a hemorrhagic stroke in the emergency room. It can also reveal ischemic strokes 6-12 hours after their onset and CT angiography can detect blockages, aneurysms, and vascular malformations in brain blood vessels.
Magnetic Resonance (MRI, MR Angiography) – a radiation-free imaging option that uses powerful magnets and radio waves to generate detailed images of the brain and detect strokes within minutes of their onset. A special type of MRI known as magnetic resonance angiography allows physicians to visualize narrowing or blockage of blood vessels, aneurysms, and vascular malformations.
Catheter based digital subtraction angiography (DSA) – considered to be the gold standard diagnostic exam for neurovascular disease. This technique is used to clearly visualize blood vessels in a bony or dense soft tissue environment.
Transcranial Doppler Examination – used to measure blood flow through the major blood vessels in the brain. The test is primarily used to detect intracranial stenosis (the narrowing of the vessels) or occlusion of blood vessels. It is also helpful in detecting vasospasm, a dangerous contraction of the wall of a blood vessel in the brain following a hemorrhagic stroke. This technique can also assess for clots traveling to the brain to cause strokes.
Transcranial Doppler Bubble Testing (TCB) – test used to determine if there is an abnormal opening between the chambers of the heart which could result in your brain receiving blood clots that may result in stroke. .
Intraoperative monitoring of intracranial blood flow) – this technique allows evaluation of cerebral blood flow during surgical or interventional procedures that might be expected to potentially compromise circulation to the brain. .
Carotid duplex ultrasound – uses imaging technology to detect blood clots, plaque build-up and other blood flow problems in the carotid arteries. It is often used in the evaluation of patients with transient ischemic attacks (TIA), stroke, and vertebrobasilar insufficiency. .
Diagnostic tests are reviewed by board-certified neurologists, radiologists, and vascular specialists and are administered by registered or certified technicians. Most of these diagnostic tests are noninvasive.
Cerebrovascular Surgery
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 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.
- Radiosurgery.
- Intracranial stenting.
- Minimally invasive clot evacuation for hemorrhages.
- Tumor embolization.
Cerebrovascular operating suites allow our team to customize aneurysm repair using open microsurgery and endovascular surgery.
Appointments & Locations
To schedule a consultation, call Cleveland Clinic Indian River Hospital and Cleveland Clinic Weston Hospital at 877.463.2010 or Cleveland Clinic Martin Health at 844.630.4968. You can also make an appointment online.
Locations
Virtual Visits
You can now stay connected to your healthcare team through virtual visits, using your smartphone, tablet or computer.
Why go virtual? It's an easy, convenient and secure way to see your provider face-to-face without having to leave home. This saves you travel time, parking fees and time spent in the waiting room — and you can also have a loved one or caregiver join you. If appropriate, you can also get a prescription sent to the pharmacy of your choice.
Many insurance companies cover the cost of virtual visits, so check with your insurance company ahead of time. Interested in getting started? Call your provider to find out what virtual visit options are available.
Stroke Awareness / Prevention
Stroke awareness
The American Stroke Association recommends that if you experience any of the following symptoms to call 911 immediately:
BE FAST
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 strange?
- TIME: If you observe any of these signs, call 9-1-1 immediately.
Stroke prevention
Stroke affects millions of Americans of various ages each year, leading to disability and death. Up to 80% of strokes can be prevented and there are things you can do to help lower your stroke risk.
Lifestyle changes which can significantly reduce your risk of a stroke include:
- Limiting alcohol intake.
- Controlling blood pressure.
- Lowering cholesterol.
- Maintaining a healthy diet.
- Managing diabetes.
- Participating in smoking-cessation programs for those who smoke.
Outcomes
With a stroke, time is brain and immediate treatment to restore blood flow is crucial. Cleveland Clinic Florida offers two types of treatment for stroke:
- Tissue plasminogen activator-tPA – A medication to treat ischemic stroke which is administered through a vein. This drug is often called a “clot busting” medication and is administered to ischemic stroke patients who meet eligibility criteria and arrive at the hospital within 0-4.5 hours of the symptom onset.
- Mechanical thrombectomy – A minimally invasive clot retrieval method that involves inserting a very small catheter through an artery until blocked blood vessel is reached, a small stent retriever is deployed, the clot is captured and removed, and blood flow is restored to the brain.
A grading system is used to measure how well blood flow is restored following mechanical thrombectomy treatment. This is called a thrombolysis cerebral infarction (TICI) score. Scoring is defined as follows:
- Grade 3 – Complete restoration of blood flow in the brain.
- Grade 2 b- Complete restoration of blood flow, but slower than normal.
- Grade 2 a- Partial restoration of blood flow to the brain.
- Grade 1 – Minimal restoration of blood flow to the brain.
- Grade 0 – No restauration of blood flow to the brain.
TICI 2b and TICI 3 are considered successful for restoring blood flow in the brain.
Cleveland Clinic Weston Hospital
TICI 2b and TICI 3 are considered successful for restoring blood flow in the brain. At Cleveland Clinic Weston Hospital, 100% of patients (August 2020- December 2020) who received thrombectomy treatment for stroke achieved a grade of TICI 2B or 3 compared to 76% patients studied nationally in recent clinical trial.
In addition, patients who undergo thrombectomy treatment for stroke are monitored closely for complications, specifically for serious bleeding events after the procedure. At Cleveland Clinic Weston Hospital patients experienced a 0% rate of bleeding complications (August 2020 – December 2020), as compared to a 7% symptomatic intracranial- hemorrhage rate seen in a recent clinical trial.
Cleveland Clinic Indian River Hospital
At Cleveland Clinic Indian River Hospital, 77% of patients (October 2021 – June 2022) who received thrombectomy treatment for stroke achieved a grade of TICI 2B or 3 compared to 76% of patients studied nationally in a recent clinical trial.
In addition, patients who undergo thrombectomy treatment for stroke are monitored closely for complications, specifically for serious bleeding events after the procedure. At Cleveland Clinic Indian River, 4.0% of patients experience any bleeding complications (January – December 2021), as compared to a 7% symptomatic intracranial hemorrhage rate seen in a recent clinical trial.
Cleveland Clinic Martin Health
At Cleveland Clinic Martin Health, 93.5% of patients ( Jan – Dec 2022) who received thrombectomy treatment for stroke achieved a grade of TICI 2B or 3 compared to 76% of patients studied nationally in a recent clinical trial.
In addition, patients who undergo thrombectomy treatment for stroke are monitored closely for complications, specifically for serious bleeding events after the procedure. At Cleveland Clinic Martin Health, 6.7% of patients experience any bleeding complications (January – December2022), as compared to a 7% symptomatic intracranial hemorrhage rate seen in a recent clinical trial.
