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CHATTANOOGA NETWORK FOR STROKE
MISSION STATEMENT AND INTRODUCTION
The Chattanooga Network for Stroke (CNS)
is a regional association of hospitals that has formed
a partnership to deliver state-of-the-art therapies
for acute stroke. Almost twenty medical centers in five
states within a 200- mile radius of Chattanooga are
participating members of CNS.
This initiative to promulgate cutting-edge standards
of stroke care could not be more timely. The Southeast
region of the U.S. is deeply embedded in an epidemiological
hot-spot popularly known as the “Stroke Belt”.
This geographical swatch has one of the highest incidence
of stroke in the country. In the United States as a
whole, approximately 700,000 people suffer a new or
recurrent stroke each year; one-third die, one-third
become disabled, and one-third recover.
There are over 3,000,000 stroke survivors in the United
States today. The current cost of stroke is estimated
to be over $50 billion per year. In this era of managed
care and cost-containment awareness, advances in stroke
management must improve patient outcomes and reduce
recurrent stroke in a cost-effective manner.
Shorter hospitalizations; briefer periods of rehabilitation;
decreased referrals to nursing homes and more frequent
return-to-work by stroke patients, are important priorities.
We believe that with advanced medical technology there’s
a great potential to meet these goals and still save
significant health-care dollars.
Current efforts are focused on thromboembolism, the
cause of most ischemic strokes. At the moment, the treatment
of choice is the thrombolytic agent, tissue plasminogen
activator (t-PA). With this “clot busting”
drug now available at all three of Chattanooga’s
main hospitals (Erlanger, Memorial, and Parkridge),
the medical profession has an effective therapy to limit
the deleterious effects of acute ischemic stroke.
At Chattanooga’s three Stroke Centers, t-PA is
administered in two ways.
- Intravenously (IV)
delivered t-PA must be initiated within 3 hours
of the onset of stroke symptoms. (Available at Erlanger,
Memorial, and Parkridge Hospitals. – see -----
for details regarding inclusion and exclusion criteria.)
- Intra-arterial (IA)
methods offer an alternative form of t-PA intervention.
This technique delivers the drug directly onto a clot
within the brain, opening a wider window for effective
treatment. The intra-arterial protocol employs a catheter
that’s inserted through the groin, fed up though
the descending aorta, through the internal carotid
artery, and directly to the source of blockage. While
this procedure is not yet FDA approved, published
clinical trials have show that IA thrombolysis is
beneficial when treating certain strokes within a
six hour time window. This has lead to the
utilization of IA t-PA widely throughout the country
in centers with appropriate facilities. (IA t-PA therapy
is currently available at Erlanger and Memorial, not
Parkridge hospital).
The advent of t-PA therapy has redefined
acute stroke intervention as a medical emergency best
represented by the phrase “TIME IS BRAIN”. Now
that emergency treatment exists for stroke patients, it
behooves each hospital in our region to establish advanced
Stroke Protocols.
The purpose of the Chattanooga Network for Stroke (CNS),
and this website (cnshelp.com), is to assist
area hospitals to develop stroke protocols that fit their
needs. It is envisioned that rapid triage will direct
patients to appropriate levels of medical care. After
this layer of screening, acute cases will be transported
to sophisticated Stroke Centers, skilled in thrombolysis.
Practical and effective implementation of emergency stroke
care requires education on many levels. Prevention through
behavior and life-style is critical. Public participation
is crucial as well. This includes: 1) the entire community;
2) emergency medical services personnel; 3) emergency
department personnel; and 4) hospital-based physicians
and allied health specialists. All four groups must be
educated simultaneously, in order to decrease the incidence
of stroke and for emergency stroke care to be successfully
delivered in our region.
Mobilizing resources of all citizens remains a major challenge
for the Chattanooga Network for Stroke.
Working together as one team, our goal is to make our
region one of the premier centers for stroke prevention
and treatment in the country. Achieving this goal will
be an accomplishment everyone can be proud of.
Thomas Devlin, M.D., Ph.D.
Executive Director, Chattanooga Network for Stroke
Director, Chattanooga Center for Neurologic Research
Copyright 2002, © University
of Miami Center for Research and Medical Education.
All rights reserved.
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