January 16, 2019 by Laura Pincus and Patty Shillington
Stroke Center to Help More Patients as Time-Frame for Treatment Expands
Baptist Hospital of Miami’s stroke center, which has been certified to treat the most complex stroke cases along with an elite group of facilities nationwide, will likely see an increase in patient volume by as much as 30 percent in coming months as a result of new guidelines from the American Heart Association/American Stroke Association (AHA/ASA).
Those guidelines expand 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.
These patients can now be treated up to 24 hours after the onset of symptoms typical for ischemic strokes, the most common type of stroke triggered by a blood clot that reduces or stops blood flow to a part of the brain. The previous “window of time” for such a procedure was 6 hours after onset of symptoms, says Felipe De Los Rios, M.D., medical director of Baptist Health Neuroscience Center’s Stroke Program at Baptist Hospital.
Two new studies prompted the major shift in treatment guidelines by the AHA/ASA late last month. Although time is still crucial in treating stroke patients after onset of symptoms — which can include numbness or weakness on one side, double vision, confusion, lack of coordination and trouble speaking — the new protocol should enable more patients to seek intervention and prevent permanent disability, said Dr. De Los Rios.
“What both of these studies were considering is moving away from the concept that only time matters,” says Dr. De Los Rios. “But some patients can hold on longer without having permanent brain injury from clots in the brain. Time is not absolutely everything. However, you still have to keep in mind that the more time that goes by, the more injury that’s likely to occur.”
Strokes are the fifth-leading cause of death in the United States and a leading cause of adult disability.
“We expect to see a higher volume of patients for this procedure at the stroke center, probably by more than 30 percent,” added Dr. De Los Rios. “We need to get information disseminated to the healthcare community, including physicians, emergency responders, ER physicians and caretakers at assisted living facilities. And, of course, the people at risk for strokes should not hesitate and come to the hospital to get help, even if they had symptoms the night before and they’re just waking up. They can still get treated.”
The Advantages of a ‘Comprehensive Stroke Center’
Three years ago, Baptist Hospital was designated by the Joint Commission, which accredits U.S. healthcare organizations, as a “Comprehensive Stroke Center.” The hospital underwent a rigorous on-site review and was shown to have the necessary requirements, including advanced imaging capabilities and neurologists, neurosurgeons and interventional neuroradiologists. Another requirement is 24/7 availability of a neuro-intensive care unit with dedicated beds for stroke patients.
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 too much alcohol. Moreover, the new guidelines don’t apply to treatment via the drug known as tPA (tissue plasminogen activator), a clot-busting solution used to treat ischemic strokes. It is the primary treatment for ischemic strokes. It is given intravenously and works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood.
“TPA medication works best for smaller blockages,” says De Los Rios. “TPA is still only approved after 4.5 hours after onset of symptoms. From 4.5 hours up to 24 hours, we can now perform thrombectomies on those with larger blockages.”
Patients may qualify for a mechanical thrombectomy if they have a blood clot in a large artery. This type of clot will not respond well to tPA medication alone and 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.
While healthcare professionals are getting familiar with the new guidelines, the most important message for the public remains recognizing the signs and symptoms of stroke and understanding that strokes are preventable, says Dr. De Los Rios.
“These new guidelines are great news for the healthcare community and those who qualify for the procedure beyond 4.5 hours,” says Dr. De Los Rios. “But the emphasis should still be on prevention because not everyone is eligible for a thrombectomy or tPA — and these people could still suffer disability.”
He adds: “So this doesn’t mean that people should stop thinking about controlling high blood pressure or getting enough exercise and eating healthier. It just means that we have better tools and can treat more patients. Prevention is still key.”