Advancing Stroke Care: New National Guidelines Increase Treatment Options

When a stroke happens, which it does about every 40 seconds in the U.S., time is critical in the race to minimize brain-tissue damage, which can lead to permanent dis- ability or even death. The sooner a stroke victim reaches emergency medical care, the more likely it is that doctors can improve the outcome.

In acute ischemic stroke—by far the most common type, accounting for about 80 percent of all strokes—a vessel that sup- plies blood to the brain is blocked by a clot. Many patients who seek care soon enough can be given clot-dissolving medication called alteplase.

Removing Clots in the Brain

For some patients who have a blockage in one of the large arteries feeding the brain, there is another highly effective option: removing the clot physically. Two TriHealth facilities, Bethesda North Hospital and Good Samaritan Hospital, have the expert teams and specialized imaging and clot-retrieval devices needed to perform this procedure, called mechanical thrombectomy.

Andrew Ringer, MD, Chief of Neurosciences with the TriHealth Neuroscience Institute and a neurosurgeon with Mayfield Brain & Spine, explains: “We can go into an artery in the groin and use X-ray guidance to steer a small device—either one that works like a fishing net or one that works like a vacuum cleaner—up to the blocked artery, then use the device to grab that blood clot and pull it out of the artery, restoring blood flow.”

The window of opportunity to treat patients with mechanical thrombectomy recently became significantly larger. New guidelines from the American Heart Association/American Stroke Association show that, in some patients, clots causing large-vessel strokes can be safely removed 16 to 24 hours after the event.

More Patients Eligible

“This is a dramatic change in the way we con- sider patients as candidates for emergency care,” says Dr. Ringer. “It wasn’t that long ago that we thought that after three hours we couldn’t do mechanical thrombectomy. That went up to four and a half hours, then up to six hours. And now, all of a sudden, it’s up to 24 hours. This is a big change in the way we approach it.”

The expanded window of treatment opportunity applies to a relatively small group of stroke patients, explains Dr. Ringer. They either woke up with stroke symptoms or for some other reason don’t know when their stroke began. In addition, their stroke must have been of a certain type, diagnosed with specialized MRI or perfusion CT scans. These are done to ensure that a certain amount of the brain tis- sue fed by the blocked artery is not yet dead and that the patient can recover once the clot is out and the stroke is minimized.

“Many people don’t meet the criteria for treatment because their stroke is too large,” says Dr. Ringer. “In that situation, there’s a risk we could make things worse, and the chance that we could make things better is very low.”

Based on the new guidelines, Dr. Ringer has already treated patients who woke up with stroke symptoms and would not previously have been considered eligible for clot removal. However, he stresses that even though doc- tors may now have more time to treat some patients, any stroke is an emergency and patients should be brought to the nearest hospital as soon as possible.

How to Recognize a stroke:

The specialists at the TriHealth Neuroscience institute educate people about stroke signs and symptoms based on guidelines provided by the American Stroke Association, which uses the acronym “BEFAST.” BEFAST stands for:

  • Balance: Watch for sudden loss of balance.
  • Eyes: Is there a sudden loss of vision in one or both eyes? Or double vision?
  • Face: Ask the person to smile and check to see if one side of the face droops.
  • Arm: Ask the person to raise both arms and see if one arm drifts downward.
  • Speech: Ask the person to repeat a simple sentence and check to see if words are slurred or the sentence is repeated incorrectly.
  • Time: If a person shows any of these symptoms, it is important to immediately call 911 and get to the hospital as quickly as possible.

The Right Care, Right Now

To improve outcomes for stroke patients, the TriHealth emergency departments (EDs) listed below have earned certification from The Joint Commission, a nonprofit organization that accredits health-care organizations

and programs. Acute Stroke Ready EDs use a standardized method of delivering care, have an acute stroke team, have a neurologist available at all times and meet other requirements. Stroke patients needing highly specialized treatment can be stabilized at the closest ED and transferred to an Advanced Primary Stroke Center,

where procedures including robotic-assisted and manual mechanical thrombectomy can be performed to remove blood clots from the brain.

Acute Stroke Ready EDs:

  • Bethesda Arrow Springs
  • Bethesda Butler Hospital
  • Good Samaritan Western Ridge

Advanced Primary Stroke Centers:

  • Bethesda North Hospital
  • Good Samaritan Hospital
Tags Heart , Innovation and Research , Neurology , Prevention and Early Detection , Rehabilitation