A Publication of WTVP

The history of the Comprehensive Stroke Center at OSF Saint Francis…

In some historical respects, 20 years seems like an eternity. The scroll wheel on the computer mouse you might be using to read this was invented by a guy at Microsoft in 1995—barely more than 20 years ago. Seems like they’ve always been a part of the computer world.

In the world of medicine, there were no stroke centers 20 years ago! There were no treatment options for acute stroke, so stroke was not considered a true medical emergency.

Building a Stroke Center
Dr. Deepak Nair is a fellowship-trained stroke and vascular neurologist with the Illinois Neurological Institute at OSF Saint Francis Medical Center. He credits a December 1995 National Institute of Neurological Disorders and Stroke/National Institutes of Health tissue plasminogen activator (tPA) trial published in the New England Journal of Medicine for proving the benefit of tPA for ischemic stroke patients.

As a stroke fellow at a hospital participating in that study, Dr. David Wang understood the impact of what was going to happen to the world of stroke. When he graduated in 1995—just before the trial results were published—he started looking for a hospital that would allow him to create a system of care for this brand-new stroke treatment. That search would soon make history.

That year, OSF Saint Francis and Central Illinois Radiological Associates (CIRA) had just hired Dr. Ken Fraser, a neurointerventional surgeon—someone with the skills to use endovascular techniques to deal with cerebrovascular disease. Dr. Fraser’s unique skillset, coupled with the ease of access to care and minimal travel times, led Dr. Wang to recognize Peoria as an ideal place to build one of the world’s first “stroke centers” to facilitate the treatment of patients who require rapid diagnosis and treatment. In 1997, he expanded it to the development of a stroke network throughout central and north-central Illinois. “He was years ahead of his time,” says Dr. Nair.

Advances in Stroke Care
“In the early years, 1996 to 2000, we treated approximately 400 ischemic strokes a year. After 2000, we treated about 500 ischemic strokes a year. After 2010, we are treating close to 800 ischemic strokes; that’s about 11,000 patients treated in 20 years,” Dr. Wang explains. “Our longstanding commitment to stroke treatment and prevention led us to become the second Comprehensive Stroke Center in the country as designated by the American Heart Association/American Stroke Association.”

Both Drs. Wang and Nair agree the discovery that tPA improves outcomes for patients is the most significant advancement in stroke care in medical history. Before that, there were no treatments for stroke patients, and tPA still remains the only medical treatment option for stroke. In 2015, another landmark discovery was made: endovascular clot retrieval that helps improve outcomes for stroke treatment.

Aside from these specific treatments, the other significant advancement in stroke care is the development of “stroke centers” themselves. Treatments like tPA and clot retrieval catheters are only effective if there is a team-based approach to the care of stroke patients; this requires collaboration of EMS systems, emergency departments, stroke teams, inpatient intensive care unit teams, rehabilitation teams, and more. It truly takes a village to care for stroke patients well, but together, these teams can more effectively help stroke patients regain independence.

Future Developments
To continue to lay a historical path, the stroke team at OSF Saint Francis is involved in continuous program development and cutting-edge research. “The future of the program lies in continuing to improve our delivery of rapid, effective stroke care—through public education, training of other healthcare professions, and developing standardized care protocols to ensure that we are consistent in our care,” explains Dr. Nair.

Future developments may include mobile stroke units, which allow for delivery of emergency department care to the patient (instead of delivering the patient to the ED); creation of a formal telestroke/teleneurology program, which would allow OSF to minimize transfer of patients between hospitals; and education of EMS groups to better equip paramedics with the tools to diagnose and triage stroke patients more rapidly to the most appropriate center for care. It’s a history that’s excitedly waiting to be written. iBi

Shelli Dankoff is media relations coordinator for OSF Healthcare System.