June 22, 2018 by John Fernandez and Tanya Racoobian
New 24-Hour Stroke Protocol Treats More At-Risk Patients
A new protocol for treating patients with the most common type of stroke – the type triggered by a blood clot that reduces or stops blood flow to a part of the brain — is helping more people at risk for permanent disability or death.
The shift in treatment was prompted by new guidelines issued in January by the American Heart Association/American Stroke Association. Essentially, the new protocol expands the pool of candidates that can have a procedure called a “mechanical thrombectomy,” in which doctors remove blood clots using a device threaded through a blood vessel.
The new guidelines says that patients can have the procedure up to 24 hours after the onset of symptoms typical for ischemic strokes. The previous time-frame for a thrombectomy was six hours after onset of symptoms.
“Now we know that people can sustain their brain function without having irreversible injury out to 24 hours (from onset of stroke),” says Felipe De Los Rios, M.D., medical director of Baptist Health Neuroscience Center’s Stroke Program at Baptist Hospital of Miami. “In the past, we thought that was impossible.”
(Watch as the Baptist Health News Team hears from Felipe De Los Rios, M.D., medical director of Baptist Health Neuroscience Center’s Stroke Program at Baptist Hospital, about crucial new guidelines for stroke treatment which are helping more people. Video by Steve Pipho.)
The extended time-frame is resulting in more patients getting this potentially life-saving procedures, says Dr. De Los Rios. More than three years ago, Baptist Hospital was designated by the Joint Commission, which accredits U.S. healthcare organizations, as a “Comprehensive Stroke Center.” This designation means that a facility has the necessary resources — including advanced imaging capabilities and neurologists, neurosurgeons and interventional neuroradiologists — to treat the most complex stroke cases.
Patients are candidates for a mechanical thrombectomy if they have a blood clot in a large artery. This type of clot usually will not respond well to tPA medication, a clot-busting solution used to treat ischemic strokes. The blood clot can cause serious complications, such as brain swelling, and can lead to considerable disability or death.
Mechanical clot removal was first recommended in 2015, and Comprehensive Stroke Centers, such as Baptist Hospital’s, are staffed and equipped to perform the procedure. During the procedure, a physician uses a device within a catheter (a thin tube threaded inside an artery) to grab and remove the clot.
The extended time-frame can save lives and prevent permanent disability for stroke victims, especially those who may have suffered a stroke in their sleep or before going to bed.
“This has been a great change because now we can treat people who wake up with stroke symptoms,” says Dr. De Los Rios. “Before, when we didn’t know when the stroke had started, it was hard to make that determination (with a smaller six-hour window). With advanced imaging, now we also can see which patients can benefit.”
Since the new guidelines went into effect, paramedics are bringing more patients to Baptist Hospital’s stroke center, he said.
Dr. De Los Rios emphasizes that people at risk for stroke should not wait longer for seeking treatment, despite this wider time-frame.
“Even though we’re able to give this treatment up to 24 hours from onset of symptoms, this doesn’t mean that people should wait before coming to the hospital,” he says. “We know that once the brain is not getting enough blood flow, there is injury happening. The more time that goes by, the more injury there is and there is less benefit from this intervention. So the sooner you get to us, the better outcome that person will have from the stroke.”
Strokes are the fifth-leading cause of death in the United States and a leading cause of adult disability.
Dr. De Los Rios stresses that prevention is still vital for anyone with stroke risk factors that include high blood pressure, high cholesterol, diabetes or pre-diabetes, physical inactivity, obesity, tobacco use and drinking too much alcohol.
Here are the top signs of a stroke, according to the American Stroke Association:
F – Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
A – Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
S – Speech Difficulty: Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
T – Time to call 9-1-1: If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.