New Guidelines Create Opportunity for Crucial Stroke Prevention Treatments

Earlier this year, the American Heart Association (AHA) expanded its guidelines for two methods of treating strokes to include practices that could prevent strokes and treat smaller strokes, expanding the number of patients who can receive crucial treatment.

The AHA now recommends that doctors use “clot-busting” drugs much earlier than previously recommended. It also recommends increasing the window of time for some patients to be eligible to have blood clots mechanically removed (also called an endovascular mechanical thrombectomy) from vessels supplying the brain — which would prevent an acute ischemic stroke.

“An acute ischemic stroke is an episode of altered brain function due to blockage of a blood vessel going to the brain,” explains Benjamin Crandall, D.O., a neuroradiologist and physician on the medical staff at Texas Health Dallas and Radiology Associates of North Texas, a Texas Health Physicians Group practice. “The brain doesn’t get enough blood, so it stops working right. The symptoms of this would correlate with the part of the brain that was involved.”

How a stroke is treated often depends on how quickly a patient seeks help.

“If the stroke patient arrives at the hospital quickly enough, they can receive intravenous clot-busting medicine called TPA (tissue plasminogen activator),” Crandall says. “If the vessel involved is large enough, then we can do an endovascular mechanical thrombectomy to remove the clot.

“This just means that we go up into the artery and try to pull the clot out of the artery so that the blood flow is restored,” he adds. “We get to this artery by going in the femoral artery in the leg, threading a catheter up the aorta and then up the carotid and into the head. It is a minimally invasive procedure.”

Both the use of the drug and the procedure are impacted by the new AHA guidelines.

“Another new recommendation broadens the eligibility for administering a clot-busting IV drug called Alteplase — a type of tissue plasminogen activator—the only FDA-approved clot-dissolving treatment for ischemic stroke,” Crandall says.

Previously, patients with mild strokes were not eligible for clot-busting treatment, but new research suggests it could help some of these patients.

“Mechanical clot retrieval is normally reserved for patients who have a large vessel blockage,” Crandall explains. “This would be either the intracranial carotid artery, proximal anterior cerebral and middle cerebral arteries or the vertebral and basilar arteries.”

In an emergency situation, Crandall simply says “time is brain cells,” so seeking medical treatment right away is important.

A simple acronym can help many identify the symptoms of a stroke in time to limit the damage.

“FAST is the mnemonic,” Crandall explains. “‘F’ stands for facial droop and an asymmetrical smile. ‘A’ stands for arms; ask the person to raise both arms and see if one is weak or drifts downwards. ‘S’ stands for speech; ask the person to repeat a simple phrase. Is their speech slurred or strange-sounding? And ‘T’ stands for time; if you observe any of these, call 911.”

By knowing the symptoms — and seeing your primary care physician yearly to keep on top of your health — you can potentially prevent a stroke, or at least minimize the damage and recovery time.

“The bottom line is that if the patient has a large stroke, and goes to a ‘stroke capable’ hospital that is able to do endovascular thrombectomy — like Texas Health Presbyterian Dallas or Texas Health Fort Worth — soon enough, then there is a good chance of opening the blood vessel and reversing the stroke symptoms,” Crandall says. “The key is getting to the right hospital in time.”

Are you looking for a primary care physician or specialist? Find a THR physician in your area with our “Find a Physician” tool. To learn more about stroke and to find an accredited stroke center nearest you, visit TexasHealth.org/Stroke or call 877-THR-WelL (1-877-847-9355).

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