Reducing Your Risk of a Stroke

Wellstar West Georgia Medical Center recently earned Primary Stroke Certification from The Joint Commission.

Offered in collaboration with the American Heart Association/American Stroke Association, achieving Primary Stroke Center (PSC) Certification means the hospital is making exceptional efforts to foster better outcomes. It’s a signal to the community that quality of care provided meets the unique and specialized needs of stroke patients.

Joint Commission-certified PSCs adhere to a set of standardized performance measures. Organizations collect monthly data for each measure in the set, and the data is then submitted quarterly to The Joint Commission.

“This important certification as a primary stroke center demonstrates our team’s commitment to a higher standard of clinical service,” says Coleman Foss, Wellstar West Georgia Medical Center President. “Stroke patients can be confident in the quality and safety of care, treatment and services delivered at West Georgia Medical Center.”

West Georgia Medical Center joins Wellstar's network of other stroke-certified hospitals, including Comprehensive Stroke Centers Wellstar Kennestone and Wellstar North Fulton, other Primary Stroke Centers Wellstar Cobb and Wellstar Spalding, and Remote Stroke Treatment Centers Wellstar Douglas and Wellstar Paulding.

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.

In March of 2021, Ashley Martin suffered cardiac arrest, which kills about 90% of people when it happens outside of a hospital. Thankfully, she was already at Wellstar Kennestone Regional Medical Center receiving the compassionate care she’d been seeking to address a long list of symptoms.

Everything began at a hectic time in Ashley’s life. She was 30 and had just gotten engaged. Wedding planning had started with the help of her fiancé and their two young boys. The hope had been to have the wedding toward the end of 2021. But the unexpected happened.

“I was always healthy,” she said. “I grew up playing sports. I was a runner. I used to get headaches, but that was the extent of my medical history.”

Finding the right care when there is more than one symptom

Symptoms of what would ultimately be diagnosed as Guillain-Barré syndrome began in February of 2021. This rare neurological disorder causes the body’s immune system to attack the nerves. 

Ashley started experiencing tingling in the tips of her hands and feet, which moved up her legs and arms as days passed. When intermittent numbness became a symptom, Ashley went to a hospital near her Peachtree City home. A clean CT and MRI meant she went home with plans to see a rheumatologist.

As she waited for her first appointment, she started feeling numbness in her feet.

“At one point, I took a step down the stairs and went tumbling down to the concrete floor,” Ashley said. 

On another trip to the hospital near her home, Ashley was diagnosed with Guillain-Barré syndrome, but treatment was unsuccessful. The numbness continued, spreading to her face. She began using a walker and, soon after, a wheelchair.

“The paralysis had moved to my abdomen,” Ashley said. “I went to sleep one night and woke up abruptly gasping for air.”

Compassionate medical care at a pivotal point

 Later that night, an ambulance brought Ashley to Wellstar Kennestone, where she would finally get the specialized neuro care she desperately needed. She was admitted to the Neurocritical Care unit, staffed by physicians, nurses and a medical team with specialized training in neurological conditions.

Upon arrival, she underwent respiratory failure due to paralysis spreading to her diaphragm. She was stabilized, but shortly after that, she experienced sudden cardiac arrest — the abrupt loss of heart function that stops blood flow to the body.

After a critical care nurse administered CPR, Ashley’s heart started beating again. Life support medications were given to keep her heart pumping.

“The neuro ICU nurses and doctors saved my life,” she said.

Later, her attending neurologist explained that the stress of her nervous system and immune system fighting, paired with respiratory failure, caused such high stress that she had a cardiac arrest.