Stroke Unit

What is a cerebrovascular accident (CVA or stroke)?

Cerebrovascular accidents (CVA or strokes) cause brain damage due to interruption of the blood flow to the area (ischemic stroke) or bleeding from a ruptured blood vessel (hemorrhagic stroke).

Globally, strokes are:

The second leading cause of death in people over 60.
The leading cause of disability among the population.
The second leading cause of dementia syndromes.

In Greece

The annual incidence of strokes in Greece is around 310 cases per 100,000 people aged 45-85, resulting in approximately 33,000 hospitalizations.
The incidence is on a constant rising trend due to the rise in the average life expectancy and the prevalence of many CVA risk factors, such as hypertension, diabetes, hyperlipidemia, smoking, alcohol, heart disease, etc.
The mortality rate after a stroke is 26% in the first month and may reach up to 37% in a year.
Around 1/3 of stroke survivors have some type of disability and require constant care, support and supervision.

In Europe, some 1,900,000 new strokes are recorded annually,
with hospitalization costs reaching €38 billion.

THE FIRST AND ONLY STROKE UNIT IN GREECE TO BE CERTIFIED BY THE EUROPEAN STROKE ORGANIZATION (ESO)

Metropolitan Hospital received yet another international accreditation, this time from the European Stroke Organization (ESO). According to the official announcement issued by the Organization, Metropolitan Hospital was awarded the ESO certificate for its Cerebrovascular Accident High Dependency Unit (Stroke Unit).

The Metropolitan Hospital Stroke Unit is the first and only recognized and certified such Unit in Greece that can receive patients 24/7 all year round. It is staffed by qualified neurologists and interventional neuroradiologists, offering top-level healthcare services. It applies all the international medical protocols for treatments that prevent disability following a stroke.

The ESO certification proves that the Metropolitan Hospital Stroke Unit neurology team is considered the best in Greece and among the leading ones worldwide.

Through this certification, Metropolitan Hospital is participating in the campaign launched by international organizations with the motto “Time is Brain”. The campaign aims to raise awareness about the disease, so that patients are brought to the hospital as soon as possible from the moment the first symptoms appear. Getting to the hospital early is the most significant factor for improving a patient’s health outcome, as it may ensure correction of any possible causes and prevent the damage from spreading.

FACTORS THAT DETERMINE THE OUTCOME OF A STROKE

1. Immediate identification of the symptoms

Many times, the first signs of a stroke that may alert the patient are transient or sudden:

Numbness or weakness of a limb
Difficulty articulating words or understanding speech
Vision impairment in one or both eyes
Difficulty walking
Instability or vertigo
Severe headache in people who do not suffer from headaches

2. 2. Getting to the hospital early

Getting to the hospital early is the most significant factor for improving a patient’s health outcome, for various reasons:

It ensures correction of any possible causes and prevents the damage from spreading.
It offers the possibility of implementing the latest treatments under certain circumstances, significantly reducing the disability and mortality rates among stroke victims.
These treatments may only be performed in the hours immediately following a stroke. The sooner they are performed, the more effective they are. Specifically, intravenous thrombolysis many only be performed within 4.5 hours and intra-arterial thrombectomy within 6 hours of a stroke.

The annual incidence of strokes in Greece is around 310 cases per 100,000 people aged 45-85, resulting in 33,000 hospitalizations.

The international organizations have adopted the “Time is Brain” motto to raise awareness about the disease, so that patients are brought to the hospital as soon as possible from the moment the first symptoms appear.

WHAT IS A STROKE UNIT?

At a Stroke Unit, fully trained neurologists and nurses specialize in monitoring and recording the vital signs of patients who have suffered cerebrovascular accidents (CVA).

The team of neurologists organizes and coordinates the individualized treatment of stroke patients, working together with other medical specialists (interventional radiologists, neurosurgeons, neuroimaging specialists, cardiologists, vascular surgeons, internal medicine specialists, physiatrists, etc.).

Diagnostic tests are also performed at the Stroke Unit, leading to the early diagnosis of the causes of stroke.

These exams assist in treating the causes that lead to deteriorating neurological signs during the first days of hospitalization and in selecting the most suitable treatment.

The following diagnostic tests may be performed:

Diagnostic testing of intracranial vessel patency and mapping of collateral circulation in real time with transcranial Doppler / Duplex, with or without contrast medium.
Continuous recording of blood flow for 60’ with transcranial Doppler, for detecting microembolisms in patients with atheromatous plaques in the extracranial vessels.
Transcranial Doppler with breath-holding, for evaluating vasomotor reactivity.
Transcranial Doppler with the use of air bubbles, for diagnosing patent foramen ovale.
Transcranial Doppler for evaluating intracranial hypertension / cerebral edema on patients with extended ischemic infarcts.

It has been proven that immediate intervention may reduce
complications by 20-50%.

BENEFITS FROM BEING HOSPITALIZED AT THE STROKE UNIT

According to the American Stroke Association guidelines (Level I scientific documentation), Stroke Units offer the following benefits:

Strokes and the complications caused by cardiovascular, respiratory and other diseases that may burden the patient’s condition are treated early. It has been proven that immediate intervention may reduce complications by 20-50%.
Hospitalization at a Stroke Unit significantly improves the disability and mortality rates.
Exact application of the international treatment protocols is possible.
The new and more effective treatments may be implemented safely for stroke and its complications, such as intravenous thrombolysis, intra-arterial thrombectomy, emergency endarterectomy, hemicraniectomy, etc.
Especially in the case of intravenous thrombolysis, it is the most modern and effective treatment for stroke patients, improving neurological deficits, disability and quality of life for all stroke patient subgroups. Thrombolysis requires constant monitoring of the patient’s neurological and vital signs in the first 24 hours of treatment and cannot be safely performed in hospital wards.
In the Stroke Unit, the doctors also evaluate the patients that must undergo emergency procedures, such as thrombectomy or thromboaspiration, emergency endarterectomy, angioplasty and stent placement, aneurysm and arteriovenous communication embolization, vasospasm treatment with medications or interventionally, etc.
Rehabilitation may start immediately, with the help of the special beds.
Hospitalization time is shorter, reducing the total costs. Specifically, patients hospitalized in a Stroke Unit stay in hospital 3 days less on average, compared to patients hospitalized in wards.

Getting to the hospital early is the most significant factor for improving a patient’s health outcome.

24/7, 365 DAYS A YEAR

UNIT PERSONNEL

Director: Eleftherios Stampoulis, Professor Emeritus of Neurology, University of Athens, assisted by external university consultants
Interventional Neuroradiologist: Georgios Magkoufis
Special HDU Neurologists: Odysseas Kargiotis, Apostolos Safouris
10 Neurologists: Associates working in shifts, 24/7
Neurosurgeons: Dimitrios Rologis and associates
Consultants: Neuroimaging specialists, cardiologists, vascular surgeons, internal medicine specialists, physiatrists, etc.
Nurses: 6 higher-education graduates