New guidelines extend treatment window for stroke

Michelle J. Smith, MD, chief of neurosurgery at Main Line Health, a member of the Jefferson Neuroscience Network

A new study from the New England Journal of Medicine has the potential to make a big difference in the lives of millions of Americans.

The study states that some patients can receive a procedure called thrombectomy up to 24 hours after the onset of stroke symptoms and still reverse or minimize the effects of stroke. In the past, doctors had only four and a half hours to perform thrombectomy.

This is a significant shift, and can improve the survival rates and quality of life for patients with stroke.

Understanding stroke treatment options

Traditionally, there are two treatment options for acute ischemic strokes. The first is an intravenous drug called tPA, tissue plasminogen activator. Delivered through an IV in the arm, tPA works to dissolve blood clots and improve blood flow.

tPA is considered a first line of defense against stroke but, in order for it to be effective, it has to be administered within three to four and a half hours. For patients who arrive at the hospital later than this, thrombectomy can be an additional option used to minimize the symptoms of stroke.

Thrombectomy is a minimally invasive endovascular procedure during which neurosurgeons or neurointerventionalists thread a catheter through a blood vessel in the groin up to a blocked blood vessel in the patient's brain to clear it.

How can thrombectomy help you?

While thrombectomy has the potential to improve the lives many patients, one group-in particular-will likely benefit from the new guidelines. Approximately 20 percent of acute ischemic strokes occur during sleep-a phenomenon known as a "wake-up stroke." In instances like these, patients wake up after sleeping with symptoms of a stroke.

It is difficult to determine what time a patient's symptoms began if they arrive with a wake-up stroke. Without this knowledge, a patient would not be eligible for intervention. With this new data, the treatment team can safely treat some wake-up stroke patients with a thrombectomy up to 24 hours.

Despite this information, it's still important to call 911 as soon as you notice the symptoms of a stroke. The faster stroke treatment starts, the better chance a patient has for recovery. There's an easy trick to help you remember the symptoms of stroke: F.A.S.T-Face drooping, Arm weakness, Speech difficulty and Time to call 911.

If you're experiencing one or more of these symptoms, call 911 for immediate medical attention.

While all Main Line Health acute hospitals are primary stroke centers--Lankenau Medical Center, Paoli and Riddle Hospitals, Bryn Mawr Hospital recently earned Advanced Thrombectomy-Capable Stroke Center accreditation from The Joint Commission. This certification signifies that the hospital meets rigorous standards for performing mechanical endovascular thrombectomy.

To learn more about stroke treatment, including thrombectomy, visit mainlinehealth.org/stroke.