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New Stroke Treatment Extends Recovery Window 
 

Imagine this: you’re at work where it’s business as usual. All of a sudden you feel the left side of your body go numb. Must be that coffee you had this morning, right? Then, you notice the left side of your mouth isn’t working quite right either and your vision is blurry. Is a new “bug” going around? No, these are telltale signs of a stroke and time is of the essence to get help.

Your brain needs a constant supply of blood to make sure your lungs, other organs and bodily functions continue to work. During a stroke, a blood vessel going to the brain becomes blocked. It’s like an accident on an interstate highway. Where once the traffic (or blood in this case) was moving smoothly, now it’s having a hard time getting through. When that happens, you only have a few precious hours before permanent, irreversible damage takes place that can result in the loss of your ability to walk, talk or even see.

Fortunately there’s a drug called tPA that hospitals use to help dissolve the clot that’s preventing blood flow. Ideally it’s given intravenously within 3 hours of the start of stroke symptoms. New research suggests it now can safely be given up to 4.5 hours after onset. But, the sooner the better because this drug also carries risk.

“The brain is soft tissue and doesn’t have the strength and toughness of the heart when you give tPA for heart attacks,” says Charles Miley, MD, medical director of the Dean & St. Mary’s Stroke Center. “When you give tPA late, there’s a much higher risk of brain hemorrhage. Current thinking is that we now can administer the treatment within the first four and a half hours of symptoms, but that means you need to be in the hospital within three and a half hours to account for prep time.”

There are other options after this critical window. One is called interarterial tPA. A catheter is inserted into the groin and is guided past the heart to the blockage near the brain. Then, the tPA is administered at the site to dissolve the clot. This therapy can work up to six hours after the start of stroke symptoms.

Before tPA was approved for use, people having a stroke had little, if any, chance of recovery. But physicians, like Dr. Miley, say they’ve seen some pretty amazing recoveries thanks to it.

“A gentleman came in with a massive stroke, was treated with tPA and was left with only a mild deficit,” says Dr. Miley. “When you’re faced with a massive stroke and a loss of independence, if there’s a reasonable chance you can reverse it with treatments like this, it’s worth a try.”

The Dean & St. Mary’s Stroke Center is one of just seven hospitals in the state that offers an additional treatment option. New this year, it’s called the Merci® Retriever. A long, thin catheter is inserted into the groin and guided up to the area of the brain where the stroke is occurring. Using X-ray technology, an interventional radiologist watches as the catheter approaches the clot. Like a sewing needle, the sharp tip passes through the clot, then turns into what looks like a coiled pig’s tail and is used to physically remove the clot from the body.

This particular treatment option only is available to stroke patients who have a complete blockage to one of the three main arteries leading into the brain. Typically, these patients have just a 20 percent chance of survival with this type of stroke. The Merci® Retriever gives medical staff up to a 12-hour window to remove the clot and gives the patient a better chance of recovery.

“It’s very exciting and we’re optimistic,” says Dr. Miley. “These are patients who have massive strokes and will not do well if we can’t do something. It definitely gives them a good fighting chance to reverse it.”

“We see a lot of strokes – about 450 per year – and there are a lot of people we’re able to help with the three treatments we have,” says Jo Goffinet, RN, MS, coordinator of the Dean & St. Mary’s Stroke Center. “The Merci® Retriever treatment is just another tool in our belt that we didn’t have in the past and are proud to offer.”

Treatments may be advancing, but strokes are still the number three killer in the United States. Time continues to be the key reason a patient with symptoms either walks away or ends up with a potentially severe disability.

“We can continue to add treatment options for stroke, but the most important thing is for people to learn and recognize the signs and symptoms of stroke and get to the hospital quickly. Depending on the type of stroke occurring, our treatment window is now up to 12 hours, but the earlier someone can get in, the greater their chance of recovery,” says Dr. Miley. “And one more thing – you can’t be too young to have a stroke. If you’re experiencing numbness on one side of your body, difficulty seeing, walking or talking call 911 immediately. It’s better to be safe than sorry.”

Stroke Stats
  • One person has a stroke in the U.S. every 45 seconds
  • Stroke is the number three killer in the U.S.
  • Stroke is the leading cause of long-term disability
  • 14% of people who survive a stroke have another one within a year
Risk Reduction
  • Watch your blood pressure
  • Quit smoking
  • Watch your weight
  • Exercise 30 minutes a day almost every day of the week
  • Keep diabetes under control
  • If your family has had strokes you’re at increased risk
Did You Know?

May is Stroke Awareness Month. Stroke affects more than 100,000 African American individuals every year. Out of those that survive one stroke, 40 percent will have another one within the next five years. It’s important to realize your risk factors and know the symptoms.

Mini-Strokes: Major Problems

TIA stands for transient ischemic attack. It’s also known as a “mini” stroke or a warning stroke. In a TIA, there is a temporary obstruction in a blood vessel which produces the typical warning signs of a stroke. Unlike a stroke, however, the obstruction does not remain in place and blood flow returns. While this may seem like a good thing, TIAs are often the red flags for a major stroke and those with these symptoms (slight numbness, slurred speech, difficulty seeing and a prolonged headache) should seek medical attention.

Call 911 Immediately If You Have:
  • Sudden numbness in your face, leg, arm or one side of your body
  • Trouble speaking, understanding or are confused
  • Difficulty seeing out of one or both eyes
  • Trouble walking
  • A sudden, severe headache without a known cause
   
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