Course Chairs

Laura E. Heitsch, MD
Joshua W. Osbun, MD

CME Provided By

Washington University School of Medicine, Continuing Medical Education

Course Co-Chair

Jin-Moo Lee, MD, PhD

Comprehensive Stroke Centers - A Growing Need

The field of stroke management is continuing to quickly evolve. Rapidly changing approaches to the management of stroke patients suggest the need to prepare physicians and allied health providers for these new developments and modifications to prior evidence – including further expansion of the potential treatment window for acute ischemic stroke to 24 hours; changes in the early identification and triage to an appropriate treatment center; and creating regional plans to handle the shift in patient triage.

There will be discussion of the current methods for cerebral aneurysms and subarachnoid hemorrhage management, the latest evidence of secondary stroke prevention, and updates on the latest stroke research and thrombolytic guidelines. There are new achievements in stroke care: new reperfusion therapies; expansion of time window when there is still enough brain tissue to save; and better understanding of neuro imaging.


The Joint Commission and the American Heart Association / American Stroke Association established the advanced certification of Comprehensive Stroke Centers to recognize hospitals that achieve higher standards and meet specific criteria for resources, staff, and training that are essential to treat the most complex stroke cases.

Every year 795,000 Americans suffer a new or recurrent stroke.  The 5th leading cause of death in the United States, stroke claims the lives of 143,000 people per year.  It has been estimated that Americans will pay about $68.9 billion dollars this year for stroke-related medical costs and disability.  Thus, stroke is a major problem in the United States and throughout the world.

Recent advances in stroke research have expanded therapeutic options.  These advances include new means of local delivery of thrombolytic agents, mechanical clot disruption, and prolongation of the therapeutic window.  In addition to acute therapies, advances are being made in interventions that can help prevent future recurrent strokes or restore function lost to stroke.

The advent of acute therapies for ischemic stroke with such a narrow time-window has forced a re-examination of how we deliver acute stroke care on a system-wide level.  The availability of an infrastructure to successfully implement acute therapies in some hospitals but not others has created some health care disparities, especially in rural states such as Missouri. Specialized medicals centers with multispecialty and collaborative groups of physicians, nurses and other health professionals that provide comprehensive stroke care from pre-hospital EMS direction to rehabilitation leading to discharge back into the community is recognized as evidence-based, comprehensive and contributes to overall better patient outcomes.