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Success of stroke treatments linked to time

TAMPA — Not long ago, there wasn't much doctors could do for people having a stroke. Most patients either died or were disabled, unable to speak or think clearly for the rest of their lives.

"Stroke was a life sentence of misery before," says Dr. Matthew Berlet, an interventional neuroradiologist and chief of the Comprehensive Stroke Center at St. Joseph's Hospital in Tampa. "Now you have a chance. You have a chance of reversing symptoms, whereas before there was zero chance."

Recent advances, from clot-dissolving drugs and clot retrieval devices to dedicated hospital stroke teams, have revolutionized stroke treatment, saving lives and preventing disability.

But there's one critical variable: time. Medical know-how is useless if someone doesn't recognize the symptoms and call 911.

"Time is so crucial. People think, 'This will go away, I'll just lie down and it will get better', " says Berlet.

Instead, the window of opportunity for successful stroke treatment begins to close the moment symptoms start. Depending on the level of care available in your area, patients have from three to nine hours before the window slams shut.

• • •

Stroke is sometimes called a brain attack because blood flow to the brain is suddenly cut off. In most cases an artery becomes blocked, causing what is called an ischemic stroke. Less common but more deadly is a bleeding or hemorrhagic stroke, where a blood vessel bursts or leaks, spilling blood in or around the brain. Without proper blood flow, brain cells begin to die.

"Time is brain," doctors often say, meaning that the faster you get care, the more cells can be saved. That's why stroke symptoms warrant a call to 911.

Paramedics know if there is a comprehensive or primary stroke center nearby, with specially trained doctors, nurses and technicians. Stroke centers have clot-busting medication on site and specialized equipment to evaluate and treat strokes.

In the Tampa Bay area, St. Joseph's, Tampa General, Morton Plant and Sarasota Memorial hospitals have been designated comprehensive stroke centers by the Agency for Health Care Administration. More than a dozen more area hospitals are primary stroke centers; go to www.fdhc.state.fl.us and search "stroke centers'' for the list.

• • •

Treatment depends on whether the stroke is caused by a blockage or bleeding, and how much time has passed since symptoms started. If bleeding is involved, usually due to a weakened vessel wall or aneurysm that has burst, doctors may use tiny coils to close the tear and restore normal blood flow. The vessel may also be closed surgically with a metal clip.

Strokes caused by blockages have several treatment options. The clot busting drug tPA (tissue plasminogen activator) may be given through a vein in the arm, or injected directly into and around the clot in the brain.

Sometimes tPA is used in combination with other medical procedures. Depending on how quickly the patient gets to the hospital, it may also be possible to mechanically extract the clot from the artery.

Two clot removal devices are in widespread use in the United States. The Merci Retriever is a corkscrew-shaped wire that is twisted into the clot so it can be pulled out like the cork in a wine bottle. The Penumbra breaks the clot into pieces and sucks them out, like a vacuum cleaner.

Stents, the tiny mesh tubes usually associated with opening blockages in the heart, are now being studied for treatment of stroke. The stent pushes the clot against vessel walls to restore blood flow. "It's a promising option in carefully selected patients," says Dr. Michael Sloan, medical director of the Tampa General-University of South Florida stroke program.

But stroke treatment is not a one-size-fits-all proposition, which is why stroke centers offer a variety of options. "We do it all here," says Sloan, "but which one we use depends on so many factors. Type of stroke, when the stroke started, age, medical history. There's a lot to consider."

Just last weekend, Sloan treated 39-year-old Paul Parsons of Orlando, who got to the hospital too late for tPA, and wasn't a candidate for clot retrieval.

He is improving, but needs help to shower and dress, can't speak clearly or use his left hand, and likely will need physical therapy.

Parsons has many risk factors: diabetes, overweight, heart disease, drug abuse and family history of stroke. And he put off getting help for hours. He hopes others learn from him.

"Stubborn pride,'' Parsons said Wednesday, explaining his delay.

"I didn't want to listen to anybody. Look where I am now.''

Contact Irene Maher at imaher@sptimes.com

Stroke symptoms

Get help right away if you experience any of these:

. Sudden numbness, paralysis, or weakness in face, arm or leg, especially on one side

. Sudden problem with walking, balance

. Sudden vision changes

. Sudden slurred speech; trouble speaking, understanding speech, feeling confused

. Sudden severe headache that feels like the worst you've ever had

Risk factors

. Age: After 55 risk doubles each decade.

. Family history: stroke in close relatives.

. Race: African-Americans are at higher risk for death from stroke.

. Gender: Men are at higher risk, but more women die of stroke.

. Personal history: Prior stroke, heart attack and TIAs ("warning strokes'').

Protect yourself

Stop smoking; exercise regularly; maintain a healthy weight; control high blood pressure and cholesterol; limit alcohol to 2 drinks a day for men, 1 for women; don't abuse drugs, especially cocaine, amphetamines and heroin.

Success of stroke treatments linked to time 10/28/09 [Last modified: Wednesday, October 28, 2009 8:15pm]

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