Cutting-Edge Treatments Improve Stroke Outcomes

By Deborah Jeanne Sergeant

Stroke is the fifth cause of death and a leading cause of disability in the United States, according to the American Stroke Association.

A stroke happens when a blood vessel is blocked by a clot (ischemic stroke) or bursts (hemorrhagic stroke). A transient ischemic attack (TIA), often dubbed a “mini stroke,” involves a temporary clot that clears on its own. After a clot or rupture happens in a blood vessel, the brain cannot get oxygen carried by blood. That causes brain cells to die.

Fortunately, 80 percent of strokes are preventable and many strokes are highly treatable. The medication and methods for breaking up clots may offer much better outcomes for many stroke patients.

“Stroke is definitely survivable,” said physician Linda Harris, past-president of the Vascular Society of Western New York and professor of surgery, University at Buffalo. She is board certified by the American Board of Surgery in vascular surgery and general surgery.

“Treatment has advanced markedly, but it depends upon when a stroke is identified,” she added. “The sooner they get into a stroke center, the better chance they have of reviving the tissue.”

One medication used is TPA, a “clot buster that’s like Drain-o for the human system,” Harris said. “There’s much better imaging of the brain, like perfusion scans. Depending on what we see, that means the kind of therapy they’ll have.”

Medication may offer benefits up to four and a half hours after a stroke started. Previously, that window of opportunity was smaller.

Recovery depends upon the amount of brain tissue lost during the stroke.

“The quality can’t likely get worse from intervention but if you don’t get it, it’s likely to get worse,” Harris said.

Many factors can affect the efficacy of stroke treatment, right down to factors particular to the individual.

“What we’ve begun to realize is everyone’s circulation in their brain is a little different,” said physician Mary L. Dombovy, who serves as vice president of Neurosciences at Unity Rehabilitation & Neurology and as current board president for the American Stroke Association affiliate in Rochester. “The biggest thing still is it’s very time sensitive. There are some people who are a little further, three to four hours or more from the stroke that can still benefit from clot retrieval.”

The clot removal gives patients 60 percent chance of a better outcome. Dombovy said she has seen patients coming in paralyzed and unable to speak and walking out several days later.

One example would include patients who wake up with stroke symptoms. Harris said that previously no treatment would be able to help these.

What’s most important is quickly seeking treatment. Some people experience stroke symptoms but hope to recover with sleep and time. That response contributes to worse symptoms.

Larger strokes may be quickly and fatal; however, usually, secondary complications are drawn out over a longer period of time. Some people think they should avoid treatment for what they think is a stroke because they don’t want to live with disability, which can include varying degrees of paralysis and issues with speech, memory and behavior.

Or, they think that if the symptoms disappear, as with a TIA, they’re fine.

“They should absolutely go receive medical attention,” Harris said. “Immediately go to the stroke center. If it’s a TIA, they still need to get it investigated because people who have a TIA may have a major stroke.”

Milder-seeming symptoms that come and go or cease altogether may signal a larger stroke yet to come and still require prompt medical attention.

“If they have a blockage, they could benefit from treatment, even if the symptoms resolve,” Harris said. “Even if they wake up with a stroke, they should get checked out immediately.”

Providers can treat blood vessel blockages for many patients that have experienced a stroke longer than 4.5-hours ago. Guided by imaging, physicians can access the clot through the groin and “vacuum” it out.

Harris said to go directly to a stroke center, not necessarily the nearest emergency room.

“Otherwise, you may not get triaged soon enough and they might not have the right tools,” she said.

To reduce your risk of stroke, the American Stroke Association recommends:

• Monitor blood pressure.

• Control cholesterol.

• Keep blood sugar down.

• Get active.

• Eat better.

• Lose weight if you need to.

• Don’t smoke.

• Talk with your doctor about taking aspirin or other medication.