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Stroke and Neurocritical Care

The Stroke and Neurocritical Care Service treats adult patients of all ages, with all types of strokes, including those caused by both ischemia (blood clots) and intracranial hemorrhage (bleeding). UAMS was certified by the Joint Commission and the American Heart Association as a Primary Stroke Center in 2010.  Several of our faculty members are also fellowship trained in neurocritical care, providing the highest level of service for critically ill neurology and neurosurgery patients in the neurointensive care unit setting.

UAMS has full time Neuroradiology interventional services available for intraarterial delivery of the “clot-busting” drug, TPA, as well as advanced clot removal techniques including Merci thrombus retrieval, and other acute intravascular procedures.  As a certified Level 1 Trauma Center, we have a dedicated Neurological ICU service, a vascular neurosurgeon, and a dedicated trauma neurosurgeon.  We provide training in stroke and critical care neurology to both neurology and neurosurgery residents who rotate through the Neuro ICU and Stroke services.  We admit 300-350 patients with ischemic strokes or TIA and 80-110 patients with intracerebral hemorrhage each year. We also admit 50-70 patients with aneurysmal subarachnoid hemorrhages annually.

The Stroke Service of the Department of Neurology at UAMS interacts extensively with physicians and other healthcare professionals in the departments of Vascular Surgery, Neurosurgery, Cardiology, Neuroradiology, Rehabilitation, and Speech/Swallowing Disorders — all of whom make important contributions to the care of the patient with threatened or established stroke.

Neurology Stroke Faculty

The UAMS Stroke Program is currently directed by Dr. Sanjeeva Reddy Onteddu, a former UAMS Neurology resident, who joined the faculty of Neurology after completing his fellowship training at the University of Massachusetts Medical School. In addition to serving as acting Stroke Program Medical Director, Dr. Onteddu serves as acting AR SAVE Medical Director.

Arkansas SAVES Telestroke Program

One of the unique features of our program is a very well developed telestroke service called “Arkansas SAVES” which reaches the entire state and is directed by our Stroke Team.  The AR SAVES program currently connects 2 “hub” hospitals (UAMS is one hub) to 46 “spoke” hospitals throughout the state, making this the largest telestroke (and telemedicine) network in the US. Referring doctors from these sites across the state can contact a stroke specialist at UAMS 24 hours a day, 365 days per year, and receive immediate consultation regarding acute stroke care, particularly regarding use of tPA and recommendation for endovascular rescue therapy.

Stroke Research

Current research efforts in the department include participation in multi-center randomized clinical trials of stroke interventions. UAMS was a center in the PROACT II study, which established the efficacy of intra-arterial prourokinase in middle cerebral artery occlusion. UAMS was also one of the first clinical centers to become active in the Carotid Occlusion Surgery Study (COSS) study, to determine whether carotid bypass surgery plus best medical therapy, or best medical therapy alone, is best for stroke prevention when one carotid artery is completely blocked.

Together with Neuroradiology and Vascular surgery, UAMS stroke Neurologists are also participating in the Carotid Revascularization Endarterectomy Stenting Trial (CREST), which the efficacy of carotid angioplasty and stenting with that of carotid endarterectomy in patients at risk for ischemic stroke. The University of Arkansas site has been one of the most active in this trial.

The AR-SAVES telestroke network also has a prospectively collected database which is being used for epidemiological studies and other research projects. As a Primary Stroke Center, UAMS has a prospectively collected database on stroke patients started 3 years ago, and is helping to develop an Arkansas Stroke Registry.

Other active cerebrovascular research programs at UAMS include a study of sonothrombolysis in which high intensity ultrasound is directed at blood clots after injection of microbubbles, directed by Dr. William Culp in Neuroradiology.  He is also investigating a new generation of neuroprotective agents. There is also an active hypothermia research program investigating the benefits of hypothermia after cardiac arrest and other conditions.

Links and Informational Articles:

The American Stroke Association is an excellent resource for stroke information.

Recommendations for the establishment of primary stroke centers – Brain Attack Coalition

Long-term outcome after thrombolysis in telemedical stroke care

The Burden of CVD in Arkansas

The Brain Buzz Newsletter