The Health Reporter Is In: Feb. 8, 2018

The Health Reporter Is In: Feb. 8, 2018

Q: Now that some strokes can be treated in a longer time window after symptoms begin, is it still as urgent to rush to a hospital?

A: Absolutely, because the window has only been expanded for one of two critical treatments. And stroke victims are still considered to have the best survival chances when they're treated as quickly as possible.

The new guidelines released last month address treatment for the most common type of stroke, the type caused by a narrowing or blockage in arteries to the brain, called an ischemic stroke.

This type of stroke is currently treated with a clot-busting drug called tPA, administered via IV and/or a clot-retrieval procedure. But there's been a fairly narrow time window in which these treatments can be done that begins at the first symptoms — as much as three to four-and-a-half hours for the clot-busting drug (which remains unchanged) and up to six hours for the clot-retrieval procedure.

Now, based on new research, the American Heart and American Stroke associations believe certain patients can benefit from the surgical procedure, called mechanical thrombectomy, up to 24 hours after symptoms begin.

They also believe more stroke patients can benefit from the IV treatment by relaxing some older guidelines within the current time window — for example, opening up the possibility of treating some patients with milder symptoms and those over 80, according to Erin Eddy, the stroke program coordinator at Carle.

"Essentially, all the new guidelines are saying is we've been able to expand who we are able to offer the treatments to," she said.

The widened time window for mechanical thrombectomy stands to have a big impact on the many patients who wake up with a stroke after going to bed the night before feeling fine, according to Eddy and Dr. Joseph Burton, medical director of acute care medicine at Sarah Bush Lincoln Health Center in Coles County.

Those patients were automatically excluded from the treatment because it wasn't known when their symptoms actually began, Burton said.

Now that the procedure may be done up to 24 hours after symptoms begin, "that's a big window of opportunity," Eddy said.

It's important to note that the longer time frame for a thrombectomy is for carefully selected patients, she said.

The procedure is intended for patients who have clots in the large arteries supplying the brain, when IV medication alone may not be enough. But for a patient to benefit, tests much show there's enough brain tissue still viable.

"If all the brain was already dead in that area, there would be no benefit and you'd expose them to more risk," Eddy said.

Mechanical thrombectomy isn't done at all hospitals, not even all those designated primary stroke centers. In Champaign and Vermilion counties, the procedure is only available at Carle, with the nearest OSF HealthCare hospital where it's available being in Bloomington.

Hospitals that don't have the procedure, among them Sarah Bush Lincoln, transfer eligible patients to hospitals that do, Burton said.

"These studies are absolutely breathtaking. They could transform stroke-patient outcomes significantly," said Eli Heicher, director of emergency and critical care services at Sarah Bush Lincoln. "But there are a lot of moving parts we have to realign to make sure we're in coordination."

What's important for the public to keep in mind about the new guidelines is they don't change anything about what patients and their families need to do. It's still important to recognize the signs of a stroke and seek treatment as soon as possible.

"If they feel they're having stroke-like symptoms, they need to be seen immediately," Heicher said.

The local hospitals still encourage remembering the key symptoms of a stroke with the acronym FAST — which stands for facial drooping, arm weakness, speech difficulty and time to call emergency services. Other possible symptoms include numbness in the face of leg, a sudden severe headache, trouble walking and blurred or double vision.

Equally important is to recognize a lot of strokes are preventable by eliminating lifestyle risk factors, Eddy said. Among the major risk factors are high cholesterol, diabetes, smoking, untreated high blood pressure, atrial fibrillation, inactivity and an unhealthy diet.

For the best chance of survival, Eddy also encouraged calling for an ambulance to take you to the hospital if you believe you've suffered a stroke. That way, paramedics can begin treating you on the way, and the hospital can prepare for your arrival.

In recent years, only about half of the stroke patients who came to Carle arrived by ambulance, Eddy said.

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