Stroke

Stroke is a medical emergency! Call 911 immediately!

At UofL Health, we are committed to being one of the top healthcare systems in the country for providing aggressive, proven stroke care. Residents of the Louisville and Southern Indiana region who suffer a stroke can be confident they will receive the highest level of stroke care possible here.

Our services

Our mission is to provide quality, individualized health care to our citizens and reduce the incidence, morbidity and mortality of stroke through direct care, community education and research.

Combining technology, therapy and treatment, patients receive the most comprehensive care in the region. Examination, laboratory studies, cardiac tests, and state-of-the-art diagnostic imaging studies can be performed within minutes of a patient's arrival in the Emergency Department. A full range of medical and rehabilitation services is rapidly available, from a team that includes neurologists, critical care providers, interventional neuroradiologists, neurosurgeons, and cardiologists as well as nutritionists, physical and occupational therapists, speech-language pathologists, diabetic coordinators, stroke nurses.  Stroke rehabilitative care and recovery can also continue with the region’s leading inpatient stroke rehab hospital, UofL Health –Frazier Rehabilitation Institute.

With multiple stroke centers across the region, our UofL Health Stroke System offers the highest level of specialty stroke care.  Each patient has access to the unique care needed to address their individual stroke treatment.

Comprehensive Stroke Center at UofL Health – UofL Hospital

At the UofL Hospital – Comprehensive Stroke Center, directed by Kerri Remmel, M.D., Ph.D., we focus on providing care that has been shown to quickly and efficiently treat stroke patients.

Comprehensive Stroke Centers are focused on treating the most complex stroke patients.  These centers must offer 24/7 access to the most advanced diagnostic tools, specialists, and guideline recommended treatments for acute stroke management.

UofL Health – UofL Hospital has a long history of leading stroke treatment across the region and the state as we evolved to the Comprehensive Stroke Center that we are today.

In 2011, we became the first hospital in Kentucky to receive the Target: Stroke Honor Roll Award from the American Heart Association/American Stroke Association for our commitment to providing tPA (a medication that dissolves blood clots) promptly after patients arrive at the hospital.

In February 2013, UofL Hospital became home to the first Joint Commission-certified Comprehensive Stroke Center in Kentucky and the 20th in the nation. This accreditation recognizes our ability to provide the most comprehensive stroke treatments available.

UofL Health – UofL Hospital received the Stroke Gold Plus Quality Achievement Award from the American Heart Association and American Stroke Association for nine straight years. The award recognizes our commitment to and success in implementing excellent care for stroke patients.

To receive the Gold Plus award, UofL Hospital achieved 85 percent or higher adherence to all Get With The Guidelines-Stroke Quality Achievement indicators for two or more consecutive 12-month intervals, and achieved 75 percent or higher compliance with six of 10 Get With The Guidelines-Stroke Quality Measures, reporting initiatives to measure the quality of care.

These measures include aggressive use of medications, such as antithrombotics, anticoagulation therapy, deep vein thrombosis prophylaxis, cholesterol-reducing drugs and smoking cessation, all aimed at reducing death and disability and improving the lives of stroke patients.

In addition to the Get With The Guidelines-Stroke award, UofL Hospital also has been recognized as a recipient of the association’s Target: Stroke Honor Roll for improving stroke care. Over the past quarter, at least 50 percent of the hospital’s eligible ischemic stroke patients have received tissue plasminogen activator, or Alteplase, within 60 minutes of arriving at the hospital. A thrombolytic, or clot-busting agent, Alteplase is the only drug approved by the U.S. Food and Drug Administration for the urgent treatment of ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, Alteplase has been shown to significantly reverse the effects of stroke and reduce permanent disability.

Primary Stroke Centers at UofL Health – Jewish Hospital and UofL Health – Mary & Elizabeth Hospital

UofL Health – Jewish Hospital and UofL Health – Mary & Elizabeth Hospital have earned The Joint Commission’s Gold Seal of Approval® and the American Stroke Association’s Heart-Check mark and have been recertified as Primary Stroke Centers.  According to the Joint Commission, Primary stroke centers are hospitals established to offer “the critical elements to achieve long-term success in improving outcomes for stroke patients.” These centers offer a consistent approach to manage the specialized and unique care of each stroke patient.

Jewish Hospital and Mary & Elizabeth Hospital both underwent a rigorous, unannounced onsite review. During the visit, a team from The Joint Commission reviewers evaluated compliance with related certification standards including program management and delivering and facilitating clinical care. Joint Commission standards are developed in consultation with health care experts and providers, measurement experts and patients. The reviewers also conducted onsite observations and interviews. These surveyors and the rigorous certification process help to validate that the stroke centers continue to offer the appropriate level of stroke care at each type of designated stroke center.

About stroke

Kentucky is in the Stroke Belt. The Stroke Belt is an 11-state region of the U.S. where studies show the risk of stroke is 34 percent higher for the general population than it is in other areas of the country, and death rates are more than 10 percent higher than the U.S. average.

According to the American Heart/Stroke Association:

• Stroke is the fifth-leading cause of death and a leading cause of long-term disability
• Stroke is the leading cause of preventable disability
• Approximately 795,000 people in the U.S. have a stroke every year, with about three in four being first-time strokes
• On average, every 3 minutes and 17 seconds someone dies of a stroke
• More women than men have strokes each year
• African Americans are more impacted by stroke than any other racial group within the American population

Data: U.S. Centers for Disease Control and Prevention

In 2020, 2,328 Kentuckians died of a stroke. Among all states, Kentucky had the 12th-highest stroke mortality rate in the nation (42.4 deaths per 100,000 population – age-adjusted).

Data: Kentucky Office of Vital Statistics and CDC National Center for Health Statistics

In 2019, 4.9 percent of Kentuckians had been told they have had a stroke. This was higher compared to 3.1% in the United States.

Data Source: 2019 KY Behavioral Risk Factor Surveillance System

Types of stroke

Stroke is a disease that affects the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, causing brain tissue to die.

There are two types of stroke:

• Ischemic stroke: Blockage of blood flow to the brain due to a blood clot or plaque buildup in the arteries. Ischemic Strokes are the most common and represent 87% of all strokes.
• Hemorrhagic stroke: This type of stroke represents 13% of all strokes due to bleeding into the brain tissue or subarachnoid space from a ruptured blood vessel.
  • The two types of hemorrhagic strokes are subarachnoid hemorrhage and intracerebral hemorrhage.
    • Subarachnoid hemorrhage (SAH) occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull.
    • Intracerebral hemorrhage (ICH) occurs when a blood vessel bleeds into the tissue deep within the brain.

A transient ischemic attack (TIA) is a transient symptom of a stroke caused by a temporary blockage of blood flow to the brain but does not leave permanent damage. Symptoms usually resolve within a few minutes. Having a TIA is a medical emergency and increases the risk of having a stroke.

Symptoms of a stroke

Stroke is a medical emergency! Call 911 immediately!

BE FAST to spot signs of stroke

• Balance – Sudden loss of balance or coordination
• Eyes - Sudden trouble seeing or blurred vision
• Face – Sudden face drooping
• Arm – Sudden weakness or numbness of the arm or leg, especially on one side of the body
• Speech – Sudden confusion, trouble speaking or understanding speech
• Time – to call 911 for help. Time saved is brain saved!

BE FAST was developed by Intermountain Healthcare, as an adaptation of the FAST model implemented by the American Stroke Association. Reproduced with permission from Intermountain HealthCare. © 2011 Intermountain HealthCare. All rights reserved.

Risk factors

Some of the most common modifiable risk factors that can lead to a stroke are:

• High blood pressure (the No. 1 risk factor for all strokes)
• Diabetes
• High cholesterol
• Tobacco abuse
• Atrial fibrillation
• Physical inactivity and obesity
• Carotid artery disease
• Sleep apnea
• TIA
• Excessive alcohol abuse
• Illegal drug use

Awards and recognitions

The UofL Health – UofL Hospital – Comprehensive Stroke Center achieved the highest recognition with the American Heart Association/American Stroke Association, receiving the Get with the Guidelines-Stroke Gold Plus Award for the last 14 years. The recognition is awarded for meeting performance guidelines for the treatment and management of stroke patients from hospital admission to discharge.

• Target Stroke Honor Roll (2012-2016)
• AHA Gold Plus Award (2007-2020)
• Target Stroke Elite Plus Award (2015 - 2021)

Quality Measures/Public Reporting

What is Public Reporting?

Public Reporting is Information that is readily available to the public regarding a health care organization’s quality and safety of care. It can help organizations improve their services, but more importantly, this information may also help educate consumers and health care purchasers in making informed choices about their health care and the procedures performed.

What are Stroke Core Measures or Quality Reports?

The Joint Commission is an organization that accredits hospitals and health care organizations across the country. They seek to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. Stroke quality measure reports provide an overview of how well an accredited organization or certified program is performing with stroke-specific Joint Commission requirements and standards.

What is/are GWTG?

Get With The Guidelines (GWTG)-Stroke® (GWTG-S) was developed by the American Heart Association/American Stroke Association (AHA/ASA) as a national stroke registry and performance improvement program.  The primary goal of the GWTG-S® registry is to improve the quality of care and outcomes for patients hospitalized with a stroke and transient ischemic attack (TIA). The GWTG-S® registry helps achieve this goal in a variety of ways, allowing hospitals to benchmark themselves against other like facilities, stroke research, promoting stroke center certification, supporting hospital-level quality improvement initiatives, and supporting the development, growth and monitoring of regional stroke systems of care.

The below procedures are commonly performed in the diagnosis, prevention and/or treatment of stroke.

Table 1: Representation of the Complication Rate for each procedure at UofL Hospital (in red) and the National Benchmark Goal (white column labeled National Goal).

Table 2: UofL Hospital Comprehensive Stroke Center Percentage of Patients Receiving Endovascular Therapy Stroke Treatment (Blood Clot Removal from Blood Vessel) within recommended National Goal of 120 Minutes from Arrival at the Hospital

Helpful Definitions

Complication Rate: The complication rates are a percentage representing the number of patients experiencing complications related to the procedure that they had performed.

Carotid Stent: A procedure where a flexible, metallic type, tube-shaped mesh, called a stent, is implanted into the carotid artery via your upper thigh/groin area to help support the vessel walls, keeping the artery open for blood to flow more regularly. These procedures are often performed by neuro-interventionalists, interventional cardiologists and/or vascular surgeons in a radiology suite with special imaging equipment.

Carotid Endarterectomy (CEA): A surgery to remove the fat buildup (plaque) or cholesterol deposits that are creating narrowing and blockages of your carotid arteries. This is performed by a surgeon in the operating room.

Diagnostic Angiogram: An invasive imaging procedure that provides high-definition visualization of the blood vessels of your brain or neck. Sometimes the angiogram is done as a diagnostic tool to look at the blood vessels to see if there are any abnormalities. This is called a diagnostic angiogram.

Endovascular Thrombectomy (EVT):
In acute stroke patients with a large vessel occlusion (LVO), it is appropriate in some patients for an invasive procedure to be performed to retrieve the clot. This is called endovascular therapy or EVT. This may also be referred to as mechanical thrombectomy by some providers. During this procedure, a physician places a catheter through a blood vessel (artery) in the arm or leg directly up to the blood vessel in the brain where the clot is blocking blood flow to brain tissue. The clot is then removed by inserting a device into the blood clot and pulling the clot out (see pictures below). The AHA/ASA nationally recommended hospital time goal for this procedure is retrieving the blood clot from the blocked blood vessel within 120 minutes of patient arrival to the hospital.

Patient stories

Stroke survivor and caregiver support group

UofL Health’s stroke care doesn’t end when you leave the hospital. Many stroke survivors and their caregivers experience a range of emotions as they adjust back to normal daily activities. Our team is here to help. Join us for our free support groups where you can enjoy talking openly with others who share similar experiences. All are welcome.

UofL Health – Stroke – Louisville Stroke Support Group

Location and time: Crescent Hill Library, 2762 Frankfort Ave., Louisville, KY 40206
Third Friday of the month
Noon – 2 p.m.
Confirm location details and RSVP: Carrie Crockett, CSW at 502-645-5425

UofL Health – Stroke – Campbellsville Stroke Support Group

Location and time: Taylor Co Public Library, 1316 E Broadway St., Campbellsville, KY 42718
First Friday of the month
1 p.m. – 3 p.m.
Confirm location details and RSVP: Carrie Crockett, CSW at 502-645-5425

UofL Health – Stroke Virtual Stroke Support Group

Location and time: Virtually online via Zoom
Fourth Wednesday of the month
6 p.m. – 7 p.m.
Confirm details and RSVP: Carrie Crockett, CSW at 502-645-5425

Join our UofL Health – Stroke online support group on Facebook

Contact us 

If you are experiencing stroke symptoms or a medical condition that needs attention, please call 911. 

For more information about stroke, services offered through our stroke program, or for additional information and resources, please reach out to our team below.

Judy Bullard, Stroke Center Program Assistant
Phone: 502-562-8009
E-mail: Judy.Bullard@UofLHealth.org

Carrie Crockett, MSSW, CSW Stroke Continuum of Care Program Manager
Phone: 502-645-5425
E-mail: Carrie.Crockett@UofLHealth.org

For other general information about stroke and community awareness or survivor/caregiver resources, please visit https://www.Stroke.org/En/About-Stroke.