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Patients could get treated 24 hours later

With a stroke, every minute counts. The sooner you act, the better the chance of survival, and the easier it is to prevent long-term disability. But new guidelines expand the window of treatment after the onset of symptoms from six to 24 hours. 

“The new expanded treatment window for strokes could mean the difference between a person becoming disabled for the rest of their life and making a full recovery,” said Clemens Schirmer, M.D., a neurosurgeon at Geisinger. “While it’s still imperative to treat a stroke as soon as possible, and not everyone is a good candidate for this wider treatment window, it could be a life-saving change for some people who suffer strokes.”

There are two types of strokes: ischemic and hemorrhagic. Ischemic strokes happen when blood flow is blocked by a blood clot. Ischemic strokes account for 87 percent of strokes. The less-common hemorrhagic stroke happens when a blood vessel leaks or ruptures and bleeding occurs into the brain or head.

During an ischemic stroke, blood flow to the brain is blocked, depriving brain cells of oxygen. When these cells don’t have oxygen, they begin to die. The faster blood flow is restored to the brain, the better the chance a person has of making a full recovery. 

Over the last few years, physicians have been making groundbreaking progress in mechanically removing the clot blocking the vessel, also called a mechanical thrombectomy, the new optimal approach and standard of care. Now codified in the most recent version of the American Heart and Stroke Association guidelines, patients who have ischemic strokes may now be eligible for this procedure up to 24 hours after their symptoms first appear. 

To remove the clot, doctors insert a catheter into a groin artery and thread it through the body to the brain. Then, they use a suction device, stentriever or mesh to trap the clot and remove it, restoring blood flow. This type of intervention works so well that it has been viewed as the best intervention in medicine in a long time. 

Another type of treatment that has been traditionally used continues to be valuable for some patients. A drug given through an IV in the arm called tissue plasminogen activator (tPA), dissolves a blood clot that’s blocking blood flow to the brain. This can be done up to four and a half hours after stroke symptoms start. 

“Though the guidelines have changed, it’s still vital that you get immediate medical attention if you or a loved one is having a stroke,” said Dr. Schirmer. “Every minute still counts—the sooner treatment starts, the better the chance of recovery. Every 30-minute delay significantly reduces the likelihood of a good outcome.”

Most strokes are preventable. Some of the risks are high blood pressure, smoking, obesity, eating a poor diet, heart disease and high cholesterol. Your age and family history are also risk factors, as are your gender and race; women are more likely to have strokes than men, and African-Americans are at higher risk. 

“The best way to prevent a stroke is to eat a healthy diet, get exercise and maintain a healthy weight,” said Dr. Schirmer. “Get regular checkups to prevent or manage chronic health conditions.”

Getting the word out is crucial: To recognize if someone is having a stroke, think F.A.S.T.: facial drooping, arm weakness, speech difficulty, time to call 9-1-1.

Dr. Clemens Schirmer, M.D., is a neurosurgeon at Geisinger. For more information, call 800-275-6401.