Recently, the New England Journal of Medicine announced research expanding the treatment of stroke. Harold Adams, MD, director of the Division of Cerebrovascular Disorders at University of Iowa Hospitals and Clinics, talks about this expanded therapy and stroke treatment in general
What is a stroke?
The term stroke describes a number of blood vessel diseases of the brain, the most common of which are due to a blood clot closing off an artery supplying part of the brain. In many ways a stroke is to the brain like a heart attack is to the heart.
What are the symptoms of stroke?
The symptoms of stroke reflect the area of the brain that is injured by the blood clot. The most common symptoms are paralysis or weakness in one side of the body, slurred speech or difficulty finding words or talking, loss of vision, a sense of imbalance, spinning, un-coordination, and rarely, a severe headache.
Who could be affected by a stroke?
Strokes can occur in anybody of any age. Stroke can occur in children, can occur in young adults, and most commonly occurs in people over the age of 60. Age is an important risk factor. People who have heart disease, people who have diabetes, people who have high blood pressure or high cholesterol are also at an increased risk of stroke, as are those people who smoke.
How important is early treatment of stroke?
The goal of modern stroke treatment is to try to limit the brain injury, and time truly is crucial. We have therapies that prove invaluable including the clot busting drug t-PA that was in the article in the New England Journal of Medicine.
What we have found is that time is very, very important, so the earlier we can treat people, the better chance we have for success. While the article in the New England Journal of Medicine describes that we now may be able to treat people—four and one-half hours after onset of stroke—successfully with these clot busting drugs. The key message still is going to be to try to treat them earlier, because if we can restore blood supply to the brain, we have the opportunity to limit the amount of brain injury.
How has the management of strokes changed with expanded treatment?
This will hopefully allow more people to be treated. At present time—or up until this publication—our time window was three hours, but now we are going to be able to move this to four and one-half hours, which hopefully will allow more people to be treated.
However, we want to avoid delaying treatment, so the goal will still be to get to the hospital as quickly as possible, because we have much better chance for success if we can treat somebody within two hours, for example, rather than within four and one-half.
What is ‘rescue therapy’ with regard to stroke, and who qualifies for this treatment?
Rescue therapy is something that we offer at The University of Iowa. This is not available at many other institutions because it involves an integrated approach where we are trying other interventions in patients who may not be able to be treated with the intravenous tPA, or who are treated with intravenous tPA and may not improve. This involves endovascular procedures where our colleagues in the Department of Radiology place a catheter in an artery to the brain and try to reopen the artery or remove the clot.
What is the benefit of rescue therapy?
This will hopefully expand the number of people who may be able to be treated by the time window. Now, we’ve been able to move from three to four and one-half hours, now that’s an important advance, but there still may be other people we could treat with these other interventions, maybe out to six to eight hours. The chances for success are not as well established. This is not as established therapy as IV tPA, and IV tPA remains the most important treatment.
If a stroke is caught and treated in its early phases, what are the chances of a complete recovery?
The chances are quite good. In some of the studies that have been done, we found that if we can treat two people within 90 minutes, one of those two people likely will have almost complete recovery. So that’s a 50 percent success rate, which is really very good when we’re talking about severe diseases of the brain. As we move out longer from the time of stroke, the chances of success drop, and that’s why the message ‘time is brain’ is such an important component of our goals of early treatment. |
