This article was originally published on Atlanta Business Chronicle on May 19, 2023.

Stroke is the fifth leading cause of death in the United States. The Georgia Department of Public Health reports the state had the 12th highest stroke death rate in the country. Georgia is also part of the “stroke belt,” an area of the southeastern United States with stroke death rates 30% higher than the rest of the nation.

As the leading — but preventable — cause of disability, stroke can happen at any age.

Stroke is a medical emergency, meaning the blood flow to an area of the brain is cut off, depriving brain tissue of oxygen and nutrients. When this happens, brain cells start to die and abilities controlled by that area of the brain, such as speech or muscle control, are lost.

New drugs and new advanced treatments — such as the Tigertriever and Artemis — are helping reduce the death and disability impact of stroke, as well as comprehensive care programs and innovative hospital partnerships that expand stroke services into rural areas.

Physicians from Wellstar Health System and the CEO of a hospital in northeast Georgia joined Atlanta Business Chronicle to discuss stroke prevention and the future of stroke care.

Panelists & moderator

• Dr. Rishi Gupta, Endovascular Neurologist and Co-Medical Director of Neuro Care
• Dr. Ashis Tayal, Vascular Neurologist, Wellstar, Director of Neuro Care Network
• Van Loskoski, CEO, Stephens County Hospital
• David Rubinger, Market President & Publisher, Atlanta Business Chronicle; Moderator

What is stroke, screening and secondary prevention

David Rubinger: Dr. Tayal, set the stage for us about the definition of stroke.

Dr. Ashis Tayal: A stroke is a sudden injury of the brain due to blockage or rupture of an artery in the brain. Injuries to the brain and disability can vary significantly.

The most common, ischemic stroke injury, is due to obstruction of an artery that causes a loss of blood flow to a critical part of the brain which damages the brain rapidly.

The other type of stroke is hemorrhagic stroke, where there’s a rupture of an artery, bleeding into the brain, or the surfaces of the brain, and that is called an intracerebral hemorrhage or a subarachnoid hemorrhage.

Rubinger: I think Americans have become a little better educated as to who’s at risk for stroke, but why don’t you walk us through that. Who would be a potential stroke candidate?

Tayal: High blood pressure, or hypertension, is the most common risk factor for both ischemic and hemorrhagic strokes. High blood pressure is an extremely common but controllable condition. Almost 80% of people have hypertension as they’re getting older.

Other risk factors include diabetes associated with elevated blood sugars causing accelerated blockage of arteries and high cholesterol, which can be related to diet and genetics.

Atrial fibrillation, a common heart arrhythmia that occurs as people get older, also places people at risk for the most severe and disabling types of strokes. And plaque buildup in specific arteries of the neck and brain also leads to an increased risk of stroke.

Smoking is another risk factor. Many adults still smoke despite a lot of progress in stroke treatment, and smoking puts people at risk for different types of stroke.

Rubinger: What about atmospheric things like stress and other areas like that? How does that play into it? Or do those things manifest themselves because of the other underlying physical conditions?

Tayal: I don’t view stress, in and of itself, as a risk factor for stroke. I think that’s more related to people’s environments and their own personalities and how they respond to stress. I do think people who are under undue stress can have poor lifestyle habits, and those poor lifestyle habits, whether poor eating habits, smoking, weight gain or lack of exercise, can lead to conditions that increase the risk for stroke.

Rubinger: So how is the healthcare system doing treating strokes? Do you believe that what’s going on at the primary care provider’s office is helping or do we have a way to go?

Tayal: In the United States, preventive care has improved the treatment of risk factors that lead to stroke, but communities must maintain routine checkups as many of the risk factors are silent.

There are improved treatments for hypertension, more aggressive treatment for diabetes, and more efforts at smoking cessation. Just the fact that we treat hypertension better than we did a generation ago has had a great impact on lowering the prevalence of stroke.

That being said, some of the most exciting work on stroke has often been done in the area of acute treatment of stroke with clot-busting drugs, catheter-based treatments and medications to protect the brain during an acute injury.

Rubinger: Has pharmacology gotten better in terms of the hypertension medicines that are out there? Have anti-cholesterol medicines improved in recent years?

Tayal: In the past, healthcare providers were often undertreating people with hyperlipidemia — high cholesterol — and not fully appreciating the benefits of significant reductions in cholesterol levels. For example, we’ve learned that driving cholesterol down into much lower ranges under 55 mg/dL can benefit our patients who have vascular disease as a cause for their stroke.

In the fight against high cholesterol, newer medications that prevent the absorption of cholesterol are now available. Recent developments have led to the discovery of a new underutilized class of drugs called PCSK-9 inhibitors that are highly effective.

New radiation technology and refreshed waiting and treatment areas are expanding world-class cancer treatment at Wellstar Cobb Cancer Center.

Cancer care in forward motion

Wellstar Cobb Cancer Center recently installed its second TrueBeam linear accelerator, which treats various cancers, including brain, head and neck, prostate, breast, lung, skin and gastrointestinal tumors. With the linear accelerator, clinicians can adjust the size and shape of beams to a tumor’s shape and spare healthy tissue.

With the second linear accelerator, Wellstar Cobb can offer patients more flexible and convenient scheduling. “An additional linear accelerator can lead to timely treatment starts and shorter wait times,” said Dr. Nasarachi Onyeuku, a radiation oncologist at Wellstar. “It expands our ability to treat more patients with cutting-edge care, continuing our commitment to bringing world-class cancer treatment closer to home.”

In addition to state-of-the-art external beam radiotherapy, TrueBeam delivers precise, high-dose stereotactic body radiotherapy (SBRT) targeting tumors in the body. It also provides stereotactic radiosurgery (SRS) for brain or spine cancer treatment. Patients will typically receive one to five treatments.

Patient-centered care at Wellstar Cobb

Wellstar Cobb Cancer Center recently renovated its treatment areas, front desk and waiting room, making it more welcoming and comforting for patients and their families. Within the treatment areas, the suite where patients receive high-dose radiation brachytherapy, a targeted treatment that involves placing radioactive material directly into tumors or near them, also underwent renovations.

“The beautifully designed space enhances patient comfort, offering a calm, supportive environment,” Dr. Onyeuku said. “We’re currently treating breast, cervical, uterine and skin cancers, with plans to expand to other cancer types. It’s advanced, efficient care—delivered close to home and with compassion.”

Early detection and support services

Cancer care begins with prevention and early detection. Wellstar Cobb is home to a lung cancer STAT Clinic, where specialists collaborate to diagnose and begin treatment within as little as 14 days. According to research by the Cleveland Clinic, patients can spend up to eight weeks on average visiting different specialists before starting a treatment plan. Earlier treatment can lead to the best possible outcomes.

Patients at Wellstar Cobb receive support at every stage of their treatment. These services include:

• Emotional support from a social worker
• Lymphedema therapy for patients with excess fluid and swelling
• Meal planning with a dietitian
• Monthly support group
• Pain management
• Physical therapy
• Transportation assistance

“We have a superb team and state-of-the-art treatment here at Wellstar Cobb Cancer Center. And we’re backed by the resources of a nationally recognized health system,” Dr. Onyeuku said. “We are thrilled that our technology enhancements allow us to serve more people with exceptional cancer treatment.”

Learn more about cancer care in Cobb.