Our Approach to Stroke Care
The Montefiore Einstein Comprehensive Stroke Center is one of the leading destinations and referral sites worldwide for the management of vascular diseases of the brain and spine, including ischemic and hemorrhagic strokes, venous occlusive disease, vascular malformations, subarachnoid hemorrhages, traumatic injuries and congenital conditions. We are the first health system from the Bronx to the Hudson Valley to have earned the prestigious Comprehensive Stroke Center designation from the Joint Commission and are among the elite three percent of hospitals in the nation to earn this designation. We are the highest-volume stroke center in the New York Metropolitan Area, and treat one of the broadest and most diverse communities in the nation, including traditionally underserved and particularly vulnerable pediatric and adult stroke patients.
Our world-renowned experts use the most advanced and emerging imaging technology and procedures to diagnose and treat patients of all ages suffering from complex, life-threatening neurovascular conditions. Our Neurovascular Program offers a complete array of state-of-the-art solutions for the full spectrum of neurovascular diseases, including endovascular, open, minimally invasive, and hybrid surgeries.
We are widely recognized for providing exceptional patient recoveries due to our explosive innovations in care logistics, continuous technological advancements and robust community outreach to accelerate multigenerational awareness and prevention. We are ranked in the top 1% of all hospitals in the nation for neurology and neurosurgery, and Montefiore Einstein’s Burke Rehabilitation Hospital is ranked in the top one percent of all hospitals in the nation for rehabilitation, according to U.S. News & World Report. Additionally, we are recipients of the highest standard for rehabilitation medicine, a three-year designation granted by the Commission on Accreditation of Rehabilitation Facilities (CARF).
Our elite, interdisciplinary team of neurovascular experts has developed advanced fellowship programs in neurocritical care and interventional neuroradiology, and provides unique expertise in managing the full spectrum of stroke syndromes by neurologists, neurosurgeons, diagnostic and interventional neuroradiologists, neuro-anesthesiologists, rehabilitation specialists, and neurocritical care physicians.
Groundbreaking Stroke Research, Clinical Trials & Education
An internationally recognized leader in stroke research, we are spearheading and participating in numerous clinical trials to advance promising interventions for stroke prevention, treatment, recovery and rehabilitation for patients with or at risk of a stroke across all stages of life.
Montefiore Einstein is a founding partner and key member of the New York City Collaborative Regional Coordinating Center (NYCC-RCC), the largest National Institutes of Health (NIH)-funded multi-institutional consortium dedicated to stroke prevention, treatment, education and rehabilitation efforts to reduce the burden of stroke on children and adults throughout the country. Distinguished as an inaugural NIH StrokeNet Regional Coordinating Center since the inception of this highly competitive NIH initiative (StrokeNet) in 2013, we are among an elite group of only 27 centers in the nation to be awarded a five-year grant funded by the National Institute of Neurological Disorders and Stroke (NINDS). As one of the top NIH StrokeNet centers enrolling minority groups to ensure that a diverse population of patients is represented in our clinical trials, we are committed to serving children and adults who are underrepresented in stroke research, and to advancing culturally sensitive interventions and protocols for populations most at risk for stroke. We also continue to develop interdisciplinary endovascular platforms, new devices and intersectional strategies for conducting ultra-rapid clinical trials.
A collaborative effort between the NIH and Montefiore Einstein, the Icahn School of Medicine at Mount Sinai, New York University School of Medicine and other affiliated institutions and partner sites, our Regional Coordinating Center encompasses all boroughs of New York City, Westchester, Long Island and Upstate New York, as well as Nashville, TN, and we continue to expand our network, leadership, and influence. We also continue to develop interdisciplinary endovascular platforms, new devices and intersectional strategies for conducting ultra-rapid clinical trials. We prioritize and lead education, advancing programs and training for the next generation of multidisciplinary leaders in stroke care.
Advanced Treatments
We employ an integrated approach to managing life-threatening stroke conditions and devise comprehensive treatment plans to maximize our patients’ care and clinical recovery, optimizing neurological function and quality of life. Many of the nonsurgical and surgical treatments we offer at the Montefiore Einstein Comprehensive Stroke Center involve a multidisciplinary, team approach from our internationally recognized stroke experts.
The quality and speed of care that a patient receives immediately after a stroke make all the difference and require coordinated stroke diagnostics and treatment encompassing a broad range of specialties. Our center offers the latest and most advanced diagnostic and treatment approaches and technologies for the acute and long-term management and prevention of all types and causes of strokes in children and adults.
Our diagnostic neuroradiologists work to provide imaging consults, protocols, and interpretations of the latest neuroimaging techniques. Advanced imaging modalities include computed tomography (CT), CT angiography, CT perfusion, magnetic resonance imaging (MRI), MR angiography, and MR perfusion.
In addition to these advanced imaging modalities, we employ other neurodiagnostics, including gene therapies; cellular, molecular and nano-technologies; neuromodulation; and neurorehabilitation strategies, including AI, brain-computer interfaces, robotics, neural regeneration and associated plasticity paradigms to enhance clinical diagnosis and treatment.
As a designated Comprehensive Stroke Center, our renowned specialists identify and treat stroke patients, offering immediate access to stroke specialists 24 hours a day, seven days a week. We provide the latest in medical management and a complete array of leading-edge surgical solutions such as endovascular, open, minimally invasive and hybrid, in an integrated setting. Investigational therapies are also offered through our NIH-StrokeNet clinical trials consortium which can provide access to emerging treatments that are otherwise unavailable.
Buying Precious Time to Reverse Disability
Though stroke is the leading cause of adult disability in the nation, it is one of the few diseases that can be reversed if treated early enough. We provide rapid access to care for acute stroke, including the administration of thrombolytic treatment with tissue plasminogen activator (tPA), or “clot buster”, for acute ischemic stroke and advanced endovascular procedures.
Advances in imaging technology allow us to pinpoint the location of a blockage in the brain and perform a thrombectomy—a procedure in which we mechanically remove the clot to restore blood flow. By performing mechanical thrombectomies, we are able to treat well beyond the traditional 4.5-hour time limit, with some patients able to be treated up to 24 hours after the stroke. This endovascular procedure can begin to reverse disability immediately, ultimately allowing patients to walk and speak again and regain their quality of life. Since the time thrombectomy became the standard of care for acute stroke, Montefiore Einstein has grown to become one of the leading thrombectomy centers in the country.
We also utilize the latest minimally invasive and open techniques for hemorrhagic strokes, caused by bleeding in or around the brain, including surgically clipping or endovascularly blocking off the source of bleeding with a coil, decreasing its blood flow, or removing the blood to decrease pressure inside the skull.
We completed the first successful clinical trial (ENRICH) in history for intracerebral hemorrhage (ICH) demonstrating overall function and survival benefit of the surgical removal of ICH. This revolutionary trial has altered the standard of care for patients with intracerebral hemorrhage (ICH) and places Montefiore Einstein at the forefront of this life-saving treatment.
Improving Outcomes with State-of-the-Art Rehabilitation
Care starts in the emergency department and continues after the patient leaves the hospital. Our inpatient team of stroke care experts, including doctors, nurses, rehabilitation specialists and social workers, seeks to identify each patient’s stroke risk factors, maximize patient safety and ensure a smooth transition to outpatient rehabilitation and stroke prevention. Our patients receive the highest quality physical therapy and rehabilitation care at Montefiore Einstein’s Burke Rehabilitation Hospital, which is ranked in the top one percent of all hospitals in the nation for rehabilitation, according to U.S. News & World Report. Additionally, we are recipients of the highest standard for rehabilitation medicine, a three-year designation granted by the Commission on Accreditation of Rehabilitation Facilities (CARF). Montefiore Einstein also offers a support group for stroke patients and their families. Working hand-in-hand with our award-winning Caregiver Support Center, families can learn about the recovery process for stroke patients.
Research & Clinical Trials
Distinguished as an NIH StrokeNet Regional Coordinating Center, we are among an elite group of only 27 centers in the nation to be awarded with a five-year grant, funded by the National Institute of Neurological Disorders and Stroke (NINDS)/NIH, spearheading and participating in numerous clinical trials to advance promising interventions for stroke prevention, treatment, recovery and rehabilitation for patients with or at risk of a stroke across all stages of life. As one of the top NIH StrokeNet centers enrolling minority groups to ensure that a diverse population of patients is represented in our clinical trials, we are committed to serving children and adults who are underrepresented in stroke research and advancing culturally sensitive interventions and protocols for populations most at risk for stroke. We also continue to develop interdisciplinary endovascular platforms, new devices and intersectional strategies for conducting ultra-rapid clinical trials.
In collaboration with our Burke Rehabilitation Hospital, we have also launched a new research and treatment program for chronic stroke patients with upper extremity motor impairment and delayed recovery, pairing vagal nerve stimulation with a six-week, intensive rehabilitation program to improve arm and hand function in patients previously disabled by ischemic stroke.
Our scientists and researchers are conducting basic, translational and clinical research in stroke as well as other neurovascular conditions, studying women’s health and stroke, the role of rare causes of stroke, including varicella zoster, hypercoagulability, carotid web and aortic arch anatomy, stroke disparities, and novel associations between COVID-19 and stroke.
Caregiver & Family Member Support Groups
Providing care for someone with a stroke is challenging. Family may suddenly become the patient’s voice and chief advocate, which can be a heavy burden.
The Comprehensive Stroke Center has an ongoing Stroke Support Group for patients and loved ones affected by brain injury, arteriovenous malformations and hemorrhagic or ischemic strokes. The group meets monthly to discuss a variety of topics.
To get information on how to attend, call Randi Kaplan or Lynette Olmo at 718-920-8080. You may also email Randi at rkaplan@montefiore.org or Lynette at lyolmo@montefiore.org.
Your Comprehensive Stroke Center Team
David J. Altschul, MD
Daniel Antoniello, MD
Allan L. Brook, MD
Charles C. Esenwa, MD
Neil Haranhalli, MD
Kathryn F. Kirchoff-Torres, MD
Daniel L. Labovitz, MD
Seon-Kyu Lee, MD, PhD
Oleg Otlivanchik, MD, PhD
Johanna M. Seiden, MD
Sara Shapouran, MD
Richard L. Zampolin, MD
About Stroke
A stroke is often referred to as a “brain attack.” It is a sudden interruption of continuous blood flow to the brain and is considered a medical emergency. A stroke occurs when a blood vessel in the brain becomes blocked or narrowed, or when a blood vessel bursts and spills blood into the brain. Just like a heart attack, a stroke requires immediate medical attention.
Some brain cells die because they stop getting the oxygen and nutrients needed to function. Other brain cells die because they are damaged by sudden bleeding in or around the brain. Some brain cells die quickly, but many linger in a compromised or weakened state for several hours. Stroke causes permanent brain damage over minutes to hours.
With stroke, “time is brain,” meaning that the sooner treatment begins, the better. Knowing the signs of stroke and calling 911 immediately can help save a relative, neighbor or friend. With timely treatment it is possible to save these cells and greatly reduce and reverse the damage.
Types of Strokes
There are two main types of stroke. Ischemic stroke, the most common type in the U.S., accounts for approximately 80 percent of all strokes. The other kind, called a hemorrhagic stroke, accounts for the remaining 20 percent.
Ischemic Stroke
An ischemic stroke occurs when the supply of blood to one or more regions of the brain is suddenly cut off or interrupted. It is similar to a heart attack, but it occurs in the brain and causes a lack of oxygen to millions of neurons and other brain cells fed by the blocked artery. It is most commonly caused by a blood clot or cellular debris (such as plaque—a mixture of fatty substances, including cholesterol) that blocks or plugs a blood vessel in the brain. Blockages that cause ischemic strokes stem from three conditions:
- Thrombosis—A clot develops within a blood vessel of the brain and grows large enough to impair blood flow
- Embolism—A clot moves from another part of the body (such as the heart or a diseased artery in the chest or neck) into a narrower artery in the neck or brain
- Stenosis—An artery in the brain or neck narrows
Blood clots are the most common cause of artery blockage and brain infarcts (damaged or dead areas of brain tissue). Blood clotting is necessary and helpful because it stops bleeding and allows the body to repair damaged small blood vessels at the site of injury. However, blood clots that form in the heart or an artery leading to the brain or in a large vein that drains blood from the brain can cause devastating injury by blocking normal brain blood flow.
The most common cause of stenosis is atherosclerosis—a condition where deposits of plaque build along the inside of arteries, causing thickening, hardening and loss of elasticity of artery walls. It is the same condition that leads to heart attack. Arteriosclerosis is also thought to cause “diffuse white matter disease”—a common finding on MRI scans associated with damage to the wires, called axons, their insulating coating, called myelin, and leaky small blood vessels. Diffuse white matter disease increases the risk of developing cognitive impairment with aging. Vascular cognitive impairment tends to interfere with attention and the ability to plan, organize and multi-task.
Acute ischemic damage can also provoke inflammation, swelling (edema) and other processes that can continue to cause damage for hours to days after the initial insult. In large ischemic strokes, the swelling can cause the pressure inside the skull to rise to dangerous levels.
Immediately after an ischemic stroke, the brain usually contains an irreversibly damaged core of tissue and an area of viable but at-risk tissue. Restoring normal blood flow—a process called reperfusion—is essential to rescuing the tissue that is still viable. The longer reperfusion is delayed, the more cells will die.
Hemorrhagic Stroke
In a healthy brain, neurons (brain cells) do not come into direct contact with blood. The blood-brain barrier, an elaborate meshwork of tightly fitting cells that form the inside layer of tiny blood vessels called capillaries, regulates which parts of the blood can pass through to the brain cells and what substances can pass into the bloodstream.
When an artery in the brain bursts, blood gushes into or around the brain, damaging the surrounding tissue. This is called a hemorrhagic stroke. The blood that enters the brain increases the pressure inside the skull (intracranial pressure) that can cause significant tissue damage. The mass of blood compresses the adjacent brain tissue, and the toxic substances in the blood mass further injure the brain tissue.
There are three types of hemorrhagic stroke, depending on where the bleeding occurs:
- Subarachnoid hemorrhage (also known as subdural hemorrhage) involves rupture of a vessel on the surface of the brain and bleeding into the space between the brain and an envelope of tissue called the arachnoid layer
- Parenchymal or intracerebral hemorrhage involves bleeding directly into the brain tissue
- Intraventricular hemorrhage involves bleeding into or around the ventricles, the chambers in the brain that contain the cerebrospinal fluid that surrounds and bathes the brain and spinal cord
Conditions such as chronic high blood pressure (hypertension) and cerebral amyloid angiopathy (a buildup of the protein amyloid on the inside wall of blood vessels) can cause blood vessels to burst. Irregularities in the brain's vascular system (the network of arteries, veins and smaller blood vessels) can also cause hemorrhagic stroke.
Learn More About Stroke
Stroke Awareness Month at Montefiore Einstein
Join us to learn more about how to identify the signs and symptoms of a stroke, as the first 24 hours are critical to survival and recovery. Even though a stroke can happen to anyone at any time, many strokes are preventable. Now more than ever, it’s important to understand the ways you can reduce the risk of stroke for you and your loved ones.