More Stroke Patients Can Receive Critical Emergency Treatment Under New Guidelines

A stroke occurs somewhere in the U.S. about once every 40 seconds, killing about 133,000 Americans every year, according to the American Heart Association. New emergency treatment guidelines recently released by the American Heart Association/American Stroke Association mean more Americans who suffer large vessel strokes such as an acute ischemic stroke are eligible for treatments that can save their life and reduce the risk of disability. An acute ischemic stroke is caused by a blood clot that reduces or stops blood flow to a portion of the brain.

The guidelines recommend that large vessel strokes can safely be treated with mechanical thrombectomy up to 16 hours after a stroke in selected patients. Under certain conditions, based on advanced brain imaging, some patients may have up to 24 hours. A mechanical thrombectomy is a procedure during which doctors remove blood clots using a device threaded through a blood vessel. The guidelines also suggest that more people should be considered eligible for a clot-dissolving IV medication called alteplase.

“This is a dramatic change in the way we consider patients as candidates for emergency care,” says Andrew Ringer, MD, Chief of Neurosciences with the TriHealth Neuroscience Institute and a neurosurgeon with Mayfield Brain & Spine. “It wasn’t that long ago that we thought that after three hours we couldn’t do anything. That went up to four and a half hours, then up to six hours. And now all of a sudden it’s 24 hours. It’s a big change in the way we approach it.”

According to Dr. Ringer, this widely expanded window of treatment applies to a small subset of stroke patients who wake up with stroke symptoms or for some other reason do not know when their stroke began. They also must have experienced a certain type of stroke that is diagnosed with specialized MRI or perfusion CT scans. This is to ensure that a certain amount of the brain tissue fed by the blocked artery is not dead yet and that the patient can recover once the clot is out and the stroke is minimized.

The TriHealth Neuroscience Institute has the specialized imaging and clot-retrieval devices for treating eligible patients who have suffered large-vessel strokes, and in fact Dr. Ringer has already treated patients with acute stroke who woke up with stroke symptoms.

“We had no idea how long the stroke had been going on, but it was something less than 24 hours,” he says. “We did specialized imaging to show that it was not a large stroke, got the clot out and the patients made an excellent recovery and went home from the hospital.”

Dr. Ringer cautions that having a small stroke after a large vessel has been closed for more than 6 hours is the exception, not the rule.

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

Even with the new guidelines, Dr. Ringer stresses that any stroke is an emergency and should be treated as soon as possible. This is why it is important to be able to recognize the signs of a stroke. TriHealth educates 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 a 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, call 911 immediately. It is important to get to the hospital as quickly as possible.